Higher preablative serum thyroid-stimulating hormone level predicts radioiodine ablation effectiveness in patients with differentiated thyroid carcinoma

Lawal, Ismaheel; Nyakale, Nozipho; Harry, Lerwine M.; Lengana, Thabo; Mokgoro, Neo P.; Vorster, Mariza; Sathekge, Mike

doi:10.1097/mnm.0000000000000640

Cited by 7 publications

(10 citation statements)

References 21 publications

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“…Whereas the patients in the 60 ≤ TSH < 90 subgroup took the lowest dose of L-T 4 among the three subgroups, this indicated that the postoperative L-T 4 dose was not the only key factor for the withdrawal time. Most of the remaining clinical features were similar among the three subgroups and there was no statistical significance on therapeutic effects six months after the first 131 I treatment, which was inconsistent with the studies mentioned above (4,5). We then merged the three subgroups into the TSH ≥ 30 group.…”

Section: Discussionmentioning

confidence: 77%

“…Some researchers believed that a TSH of > 30 mU/l or THW over two weeks was not in itself required for successful 131 I treatment (6, 7). On the contrary, others suggested that DTC patients might achieve a better response to 131 I treatment after a stronger TSH stimulation level due to a probable higher 131 I uptake (4,5).…”

Section: Discussionmentioning

confidence: 98%

“…Indeed, this recommendation is based solely on an old paper published in 1977 (3). It is controversial that some clinicians believe that DTC patients with higher TSH stimulation levels will achieve a better clinical response than patients with lower TSH levels (4,5). In contrast, other researchers demonstrated that DTC patients achieving TSH stimulation levels < 30 mU/l or thyroid hormone withdrawal (THW) less than two weeks before 131 I treatment did not show a significant difference in treatment effect in comparison with those whose TSH stimulation levels were ≥ 30 mU/l or THW lasting three to four weeks (6,7).…”

Section: Introductionmentioning

confidence: 99%

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The Influences of TSH Stimulation Level, Stimulated Tg Level and Tg/TSH Ratio on the Therapeutic Effect of 131I Treatment in DTC Patients

et al. 2021

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PurposeTo study the influences of pre-ablation TSH stimulation level, sTg and sTg/TSH ratio on the therapeutic effect of the first 131I treatment in DTCs.MethodsAccording to the thyroid stimulating hormone (TSH) levels (mU/l), all the 479 differentiated thyroid cancer (DTC) patients were divided into two groups: TSH < 30 and TSH ≥ 30. The TSH ≥ 30 group was divided into three subgroups: 30 ≤ TSH < 60, 60 ≤ TSH < 90 and TSH ≥ 90. The clinical features and the therapeutic effects of the first 131I treatment were analyzed. The cutoffs of stimulated thyroglobulin (sTg) and sTg/TSH ratio were calculated to predict the therapeutic effect of 131I treatment.ResultsAmong the three subgroups, the TSH ≥ 90 subgroup was younger and less likely to be associated with cervical lymph node metastasis (LNM). The postoperative levothyroxine (L-T4) dose in the 60 ≤ TSH < 90 subgroup was the lowest. Between the two groups, patients in the TSH < 30 group had higher postoperative L-T4 dose and longer thyroid hormone withdrawal (THW) time. The excellent response rates six months after the first 131I treatment among the three subgroups and between the two groups were not of statistical significance. The distribution of different TSH stimulation levels among each response group was similar. The cutoffs for the better therapeutic effect of the first 131I treatment in sTg and sTg/TSH were < 9.51 ng/ml and < 0.11, respectively. Both univariate and multivariate logistic regressions showed that cervical LNM, distant metastasis, higher sTg and higher sTg/TSH ratio predicted poorer therapeutic effect.ConclusionsThere was no significant influence of TSH stimulation levels before the first 131I treatment on the therapeutic effect of DTC. The sTg/TSH ratio can be considered as another predictor of 131I therapeutic effect.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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The Influences of TSH Stimulation Level, Stimulated Tg Level and Tg/TSH Ratio on the Therapeutic Effect of 131I Treatment in DTC Patients

et al. 2021

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“…published a report on patients who received ablation with TSH <30, with the same ablation outcome ( 44 ). On the other hand, some authors advocate the use of higher TSH values, suggesting them to be connected with better treatment outcome ( 45 , 46 ). In our two previous studies, no differences were observed comparing TSH levels and the ablation outcome ( 47 , 48 ).…”

Section: Cut-off Tsh Threshold Of 30 Miu/lmentioning

confidence: 99%

Thyroglobulin as a Tumor Marker in Differentiated Thyroid Cancer – Clinical Considerations

Prpić

Franceschi

Romić

et al. 2018

ACC

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SUMMARY – Initial treatment of the majority of patients with differentiated thyroid cancer (DTC) includes total thyroidectomy. Postoperative ablation therapy with radioactive iodine (I-131) is indicated in all high-risk patients, however, there is disagreement regarding its use in low- and intermediate-risk patients. Over the last few decades, thyroglobulin (Tg) has been established as the primary biochemical tumor marker for patients with DTC. Thyroglobulin can be measured during thyroid hormone therapy or after thyroid-stimulating hormone (TSH) stimulation, through thyroid hormone withdrawal or the use of human recombinant TSH. In many studies, the cut-off value for adequate Tg stimulation is a TSH value ≥30 mIU/L. However, there is an emerging body of evidence suggesting that this long-established standard should be re-evaluated, bringing this threshold into question. Recently, a risk stratification system of response to initial therapy (with four categories) has been introduced and Tg measurement is one of the main components. The relationship between the Tg/TSH ratio and the outcome of radioiodine ablation has also been studied, as well as clinical significance of serum thyroglobulin doubling-time. The postoperative serum Tg value is an important prognostic factor that is used to guide clinical management, and it is the most valuable tool in long term follow-up of patients with DTC.

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“…Therefore, it is critical to identify the predictors for the response to therapy. Previous studies showed some clinicopathological features (e.g., sex, tumor size, lymphovascular invasion, number of metastatic lymph nodes [LNs], ratio of metastatic to examined LNs [LNR], extranodal extension, and preablative-stimulated thyroglobulin [Ps-Tg]) may affect the response to therapy (5)(6)(7)(8)(9)(10)(11). However, these results are based on retrospective single-center studies, and some of them are inconsistent.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors for Excellent Response to Initial Therapy in Patients With Papillary Thyroid Cancer From a Prospective Multicenter Study

Dong

Zhang

et al. 2022

Front. Oncol.

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Prognostic factors for excellent response (ER) to initial therapy in patients with papillary thyroid cancer (PTC) have not been determined. In this study, we investigated the response to initial therapy in PTC patients and independent prognostic factors for ER in a prospective multicenter study in China. A total of 506 PTC patients from nine centers in China were enrolled in this study, all of whom underwent total or near total thyroidectomy with lymph node dissection and subsequent radioiodine therapy. Univariate and multivariable logistic regression analyses were carried out to determine the independent prognostic factors for ER. The optimal cutoff value of the number of metastatic lymph nodes for predicting ER was determined by the receiver operating characteristic curve. A total of 139 patients (27.5%) achieved ER after initial therapy. Extrathyroidal extension, the number of metastatic lymph nodes, and preablative-stimulated thyroglobulin (Ps-Tg) were independent risk factors for ER for the entire population. In a subgroup analysis, extrathyroidal extension and Ps-Tg were independent risk factors for ER in pathological N1a patients, while the number of metastatic lymph nodes and Ps-Tg were independent risk factors for ER in pathological N1b patients. The appropriate cutoff values of the number of metastatic lymph nodes in predicting ER were 5 and 13 for the entire population and pathological N1b PTC patients, respectively. PTC patients with more metastatic lymph nodes were more likely to fail to achieve ER. Extrathyroidal extension, the number of metastatic lymph nodes, and Ps-Tg were important prognostic factors for ER after initial therapy in PTC patients.

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Higher preablative serum thyroid-stimulating hormone level predicts radioiodine ablation effectiveness in patients with differentiated thyroid carcinoma

Abstract: Higher preablative serum TSH predicts a better rate of ablation in patients with differentiated thyroid cancer treated with I after thyroidectomy.

Cited by 7 publications

References 21 publications

The Influences of TSH Stimulation Level, Stimulated Tg Level and Tg/TSH Ratio on the Therapeutic Effect of 131I Treatment in DTC Patients

The Influences of TSH Stimulation Level, Stimulated Tg Level and Tg/TSH Ratio on the Therapeutic Effect of 131I Treatment in DTC Patients

Thyroglobulin as a Tumor Marker in Differentiated Thyroid Cancer – Clinical Considerations

Prognostic Factors for Excellent Response to Initial Therapy in Patients With Papillary Thyroid Cancer From a Prospective Multicenter Study

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