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Follow-Up of Low-Risk Differentiated Thyroid Cancer Patients Who Underwent Radioiodine Ablation of Postsurgical Thyroid Remnants after Either Recombinant Human Thyrotropin or Thyroid Hormone Withdrawal

Department of Endocrinology and Metabolism (R.E., E.M., L.G., A.P.), University of Pisa, 56124 Pisa, Italy; Institut Gustave Roussy and University of Paris-Sud XI (M.S., S.L.), 94805 Villejuif, France; Division of Nuclear Medicine (A.D., I.R.), University of Western Ontario, London, Ontario, Canada N6A 4G5; Department of Nuclear Medicine (C.R., M.Lu., M.La.), University of Wuerzburg, 97070 Wuerzburg, Germany; The Ohio State University (R.T.K.), Columbus, Ohio 43210; The University of Texas M. D. Anderson Cancer Center (S.I.S., N.L.B.), Houston, Texas 77030; University of Colorado Denver (B.H.), Aurora, Colorado 80045; Centre Rene Huguenin (C.C.), 92210 Saint Cloud, France; Division of Nuclear Medicine (R.L.W., S.Y.C.) and Division of Endocrinology and Metabolism (P.W.L.), Johns Hopkins University, Baltimore, Maryland 21287; Section of Endocrinology and Metabolism (F.P.), University of Siena, Siena 53100, Italy; and Genzyme Corp. (J.M.), Cambridge, Massachusetts 02142

Address all correspondence and requests for reprints to: Rossella Elisei, Department of Endocrinology, University of Pisa, 56124 Pisa, Italy. E-mail: relisei{at}endoc.med.unipi.it.

Background: We previously demonstrated comparable thyroid remnant ablation rates in postoperative low-risk thyroid cancer patients prepared for administration of 3.7GBq ¹³¹I (100 mCi) after recombinant human (rh) TSH during T₄ (L-T4) therapy vs. withholding L-T4 (euthyroid vs. hypothyroid groups). We now compared the outcomes of these patients 3.7 yr later.

Patients and Methods: Fifty-one of the 63 original patients (28 euthyroid, 23 hypothyroid) participated. Forty-eight received rhTSH and serum thyroglobulin (Tg) sampling. A ¹³¹I whole-body scan was performed in 43 patients, and successful ablation was defined by criteria from the previous study. Based on the criterion of uptake less than 0.1% in thyroid bed, 100% (43 of 43) remained ablated. When no visible uptake instead was used, five patients (four euthyroid, one hypothyroid) had minimal visible activity. When the TSH-stimulated Tg criterion was used, only two of 45 (one euthyroid, one hypothyroid) had a stimulated Tg level greater than 2 ng/ml.

Results: No patient in either group died, and no patient declared disease free had sustained tumor recurrence. Nine (four euthyroid, five hypothyroid) had received additional ¹³¹I between the original and current studies due to detectable Tg or imaging evidence of disease; with follow-up, all now had a negative rhTSH-stimulated whole-body scan and seven (three euthyroid, four hypothyroid) had a stimulated serum Tg less than 2 ng/ml.

Conclusions: In conclusion, after a median 3.7 yr, low-risk thyroid cancer patients prepared for postoperative remnant ablation either with rhTSH or after L-T4 withdrawal were confirmed to have had their thyroid remnants ablated and to have comparable rates of tumor recurrence and persistence.