Recombinant human thyrotropin versus thyroid hormone withdrawal preparation for radioiodine ablation in differentiated thyroid cancer: Experience in a South Taiwanese medical center

Abstract

This retrospective study was designed to compare the treatment response of patients with differentiated thyroid cancer (DTC) prepared for radioiodine ablation (RIA) with thyroid hormone withdrawal (THW) or recombinant human thyrotropin (rhTSH) stimulation. Patients with DTC were followed-up retrospectively between 2013 and 2018 in Kaohsiung Chang Gung Memorial Hospital, Taiwan. We compared the excellent response ratios between THW (49.9%) and rhTSH (50.1%) stimulation.Patients were then divided into subgroups, on the basis of age, sex, extrathyroidal extension, lymph node metastasis, and tumor-node-metastasis stage, for analysis. In all, 647 patients were followed-up after RIA. The ratios of THW or rhTSH use in the different subgroups were not statistically significant. In all the patients, the excellent response rate with THW and rhTSH was 80% and 76.5%, respectively, which was not statistically significant. The subgroup analysis, including age, sex, extrathyroidal extension, lymph node metastasis, and tumor-node-metastasis stage (low and high risk), showed similar results. Furthermore, the logistic regression analysis revealed no statistically significant differences among the subgroups. The multivariate analysis showed extrathyroidal extension, lymph node metastasis, and high I 131 dose were the prognostic factors affecting the excellent response rate. In conclusion, the THW and rhTSH preparations for RIA were similar in terms of the excellent response rates and subgroup clinical outcomes.

Comparison of Recombinant Human Thyroid-Stimulating Hormone and Thyroid Hormone Withdrawal for 131I Therapy in Patients With Intermediate- to High-Risk Thyroid Cancer

“…The included articles were exclusively retrospective case-control studies that were conducted in Europe, 12,20,29 North and South America, [22][23][24][25]27,30,33 and East Asia. 21,26,31 The characteristics of the included studies and patient populations are summarized in Tables 1-4.…”

“…Eight studies compared the rate of RRA between rhTSH and THW groups in intermediate-or high-risk patients (Table 1). 12,[20][21][22][23][24][25][26] Clinical Nuclear Medicine • Volume 49, Number 3, March 2024 rhTSH in High-Risk DTC: A Meta-analysis Detailed demographic data and clinical characteristics are presented in Table 2. Although most studies excluded patients with distant metastases from the analysis, 1 study did include such patients.…”

“…For intermediate-to high-risk patients without distant metastases, RAI therapy is used to ablate remnant normal thyroid tissue and identify residual or metastatic lesions. 12,[20][21][22][23][24][25][26] In contrast, for high-risk patients with distant metastases, RAI therapy is intended as a therapeutic intervention after the detection of metastases. [27][28][29][30][31] Consequently, the evaluation of treatment efficacy for these distinct patient groups requires different outcome measures compared with those undergoing remnant ablation.…”

“…According to the guidelines of the American Thyroid Association 2015, 19 the goals of RAI therapy are different for individuals with intermediate risk and those with high risk, including patients with metastases. For intermediate- to high-risk patients without distant metastases, RAI therapy is used to ablate remnant normal thyroid tissue and identify residual or metastatic lesions 12,20–26 . In contrast, for high-risk patients with distant metastases, RAI therapy is intended as a therapeutic intervention after the detection of metastases 27–31 .…”

Thyroid Hormone Withdrawal versus Recombinant Human TSH as Preparation for I-131 Therapy in Patients with Metastatic Thyroid Cancer: A Systematic Review and Meta-Analysis

“…The studies included a total of 1929 patients, of whom 953 were pre-treated with rhTSH and 976 with THW. Four studies were conducted in the United States [22][23][24][25], two in Brazil [26,27], one each in Italy [28], Portugal [20], Taiwan [29], and Canada [30]. The observation period ranged from 1993 [25] to 2019 [26], with a range of five years [29] to twenty-two years [26].…”