Recombinant human TSH versus thyroid hormone withdrawal in adjuvant therapy with radioactive iodine of patients with papillary thyroid carcinoma and clinically apparent lymph node metastases not limited to the central compartment (cN1b)

Abstract

Objective To compare the short- and long-term outcomes of adjuvant therapy with radioactive iodine (RAI) preceded by the administration of recombinant human TSH (rhTSH) versus thyroid hormone withdrawal (THW) in patients with papillary thyroid carcinoma and clinically apparent lymph node metastases not limited to the central neck compartment (cN1b). Subjects and methods The sample consisted of 178 cN1b patients at intermediate risk who underwent total thyroidectomy with apparently complete tumor resection [including postoperative ultrasonography (US) without anomalies] and who received adjuvant therapy with RAI (30-100 mCi) preceded by the administration of rhTSH (n = 91) or THW (n = 87). Results One year after RAI, the rates of excellent response to therapy, i.e., nonstimulated thyroglobulin (Tg) ≤ 0.2 ng/mL with negative antithyroglobulin antibodies and negative neck US, and of structural disease were similar for the two preparations (84% and 4.5%, respectively, in both groups). During follow-up (median 66 months), the rate of structural or biochemical (nonstimulated Tg > 1 ng/mL, with increment) recurrence was also similar in the two groups (4.5%). In the last assessment, the percentage of patients without evidence of disease, i.e., nonstimulated Tg < 1 ng/mL and no evidence of structural disease, was similar for the two preparations [92.3% in the rhTSH group and 97.7% in the THW group (p = 0.17)]. Conclusion Preparation with rhTSH was equally effective (short- and long-term) as THW for adjuvant RAI therapy of cN1b patients at intermediate risk and with apparently complete tumor resection.

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

“…In addition, the meta-analysis of patients with distant metastases showed no significant difference in the DCR between the 2 groups. Although survival outcomes were not the primary focus of the current meta-analyses, assessments of survival outcomes or disease status at last follow-up in patients with the intermediate-to high-risk DTC 22,24,25,27,[29][30][31][38][39][40] were eligible for systematic review among the included articles (Supplemental Digital Content, Tables S1 and S2, http://links.lww.com/CNM/A457). Despite the inability to conduct a meta-analysis due to the heterogeneity of survival criteria in the studies, no significant differences in clinical outcomes were observed between the rhTSH and THW groups.…”

“…1), a total of 13 articles were finally selected for review and meta-analyses for the primary outcomes. 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.…”

“…S3, http://links.lww.com/CNM/A457). Furthermore, another subgroup analysis of patients with N1 12,23,25,33 showed a pooled RR of RRA success of 1.165 (95% CI, 0.973-1.395; I 2 = 69%; Supplemental Digital Content, Fig. S4, http://links.lww.com/CNM/A457).…”

“…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.…”