Surgery and radioablation therapy combined: introducing a 1-week-condensed procedure bonding total thyroidectomy and radioablation therapy with recombinant human TSH

Abstract

Objective: The objective of this study was to determine whether the use of recombinant human TSH (rhTSH) to stimulate radioiodine uptake after thyroidectomy is as efficacious as a period of withholding thyroid hormones, while at the same time avoiding hypothyroidism, reducing sick leave time and shortening the hospital stay. Design: Our aim was to compare the standard procedure of differentiated thyroid cancer treatment, which consists of thyroidectomy followed by 4 weeks of hypothyroidism and a conclusive ablative activity of 131 iodine, with a new shortened treatment in which L-thyroxine (T 4 ) medication is initiated a day after thyroidectomy, followed by application of rhTSH stimulation and subsequent ablation a few days after surgery. We presumed our treatment to represent the most sophisticated strategy for the reduction in sick leave days overall without any reduction in safety or the efficacy of ablative therapy. Methods: Patients (nZ25) were randomized either for surgery and rhTSH stimulation or surgery and L-T 4 abstinence before the first application of radioiodine. Ablation success was determined by neck ultrasound and serum thyroglobulin during follow-up. RhTSH receivers were monitored for an average of 635 days (S.D.G289) and patients in L-T 4 abstinence for an average of 624 days (S.D.G205). Both groups were statistically compared for significant differences in treatment efficacy, safety and overall time of sick leave. Results and conclusions: Our shortened treatment proved to be equally efficacious and safe in comparison with the conventional therapy regimen. At the same time, it showed economic advantages through the reduction in average sick leave time from w29 days (L-T 4 abstinence) down to w6 days (rhTSH stimulation) as well as sustaining the patient's quality of life by the complete avoidance of hypothyroidism.

Predictors of return to work and employment in cancer survivors: a systematic review

“…; Emmanouilidis et al . ). Four out of 12 articles reporting significant data were of high quality (Van den Brink et al .…”

A Systematic Review of Adjuvant Interventions for Radioiodine in Patients with Thyroid Cancer

“…There were 4 types of interventions in these included trials. 8 studies compared recombinant human thyroid-stimulating hormone (rhTSH) with conventional thyroid hormone withdrawal (THW) to stimulate TSH in order to prepare for the ablation of post-surgical thyroid remnants [3,4,5,6,7,8,9,10]. In these, 2 trials were randomized not only to 2 different methods for TSH stimulation (rhTSH or THW), but also to high versus low radioiodine doses [8,9].…”

“…Seven studies indicated a successful ablation rate when comparing rhTSH and THW [3,4,5,6,7,8,9]. The pooled risk ratio showed no statistically significant difference in the successful thyroid remnant ablation for rhTSH versus THW (risk ratio = 0.99, 95% CI = 0.96-1.02, p = 0.58; fig.…”

Risk factors associated with high thyroglobulin level following radioactive iodine ablation, measured 12 months after treatment for papillary thyroid carcinoma

“…According to the ATA guidelines, rhTSH stimulation shows similar outcomes for achieving remnant ablation, based on evidence of superior short-term quality of life, noninferiority of remnant ablation efficacy, and multiple consistent observations suggesting no significant difference in long-term outcomes compared to THW [6]. Emmanouilidis et al [29] also showed that there was no statistically significant difference in mean Tg levels directly before the first RAI ablation and on the last follow-up between patients treated with rhTSH stimulation and THW.…”