Analysis of Clinical Factors for the Determination of Optimal Serum Level of Thyrotropin After Recombinant Human Thyroid-Stimulating Hormone Administration

Son, Seung Hyun; Lee, Sang‐Woo; Jung, Ji-hoon; Kim, Choon-Young; Kim, Do-Hoon; Jeong, Shin Young; Ahn, Byeong‐Cheol; Lee, Jaetae

doi:10.1007/s13139-015-0348-y

Cited by 9 publications

(9 citation statements)

References 26 publications

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“…Even though cervical mLN might be present, it would be too small to be detected on preoperative US, which might mean no suspicious macrometastatic LN. Third, RAI was administered either after rhTSH or after THW, and the TSH-stimulated serum Tg levels might be affected by methods for TSH elevation [ 19 ]. However, in the current study, the TSH-stimulated serum Tg levels did not significantly differ according to the type of method for TSH elevation applied in the low-risk group (THW vs. rhTSH: 1.81±3.01 ng/ml vs. 1.86 ±1.99 ng/ml, p = 0.628), or in the intermediate-risk group (THW vs. rhTSH: 2.23±4.18 ng/ml vs. 3.56 ±4.28 ng/ml, p = 0.452).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for radioactive iodine-avid metastatic lymph nodes on post I-131 ablation SPECT/CT in low- or intermediate-risk groups of papillary thyroid cancer

et al. 2018

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ObjectivePost I-131 ablation single-photon emission computed tomography (SPECT)/CT can show radioactive iodine (RAI)-avid cervical metastatic lymph nodes (mLN) in differentiated thyroid cancer. This study aimed to evaluate the incidence of RAI-avid mLN on post I-131 ablation SPECT/CT and the risk factors related to metastasis among patients with papillary thyroid cancer (PTC) in the low- or intermediate-risk groups.Study design and settingAmong 339 patients with PTC who underwent total thyroidectomy followed by I-131 ablation, 292 (228 women, 64 men) belonging to the low- or intermediate-risk groups before I-131 ablation, and with sufficient clinical follow-up data were enrolled. The risk groups were classified based on the American Thyroid Association 2015 guideline. Each patient was followed-up for at least 24 months after the ablation (median: 30 months). The clinical, pathologic, and biochemical factors of PTC were reviewed, and their relationships to RAI-avid mLN on SPECT/CT were analyzed.ResultsOf the 292 patients, 61 and 231 belonged to the low-and intermediate-risk groups, respectively. Four (6.5%) patients in the low-risk group and 31 (13.0%) patients in the intermediate-risk group had RAI-avid mLN. A high preablation TSH-stimulated serum thyroglobulin (Tg) level in the low- or intermediate-risk group predicted the presence of RAI-avid mLN (cut-off = 0.5; hazard ratio (HR): 2.96; p = 0.04). In the subgroup analysis by risk group, TSH-stimulated serum Tg only predicted RAI-avid mLN in the low-risk group (cut-off = 1.0; HR: 5.3; p = 0.03).ConclusionThe incidence of RAI-avid mLN on postablation SPECT/CT was relatively high in both low- and intermediate-risk patients with PTC, and high preablation TSH-stimulated serum Tg level was a predictor of metastasis, especially in the low-risk group. A selective treatment approach should be considered in patients with high preablation TSH-stimulated serum Tg level.

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Section: Discussionmentioning

confidence: 99%

Risk factors for radioactive iodine-avid metastatic lymph nodes on post I-131 ablation SPECT/CT in low- or intermediate-risk groups of papillary thyroid cancer

et al. 2018

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“…Because they already performed that thyroid hormone withdrawal and TSH level below 30 mIU/L are generally not considered for RAI therapy in these studies. Age, body surface area, body mass index, and creatinine show a relationship with TSH elevation, and creatinine is the most powerful predictor [52]. Although recombinant human TSH (rhTSH) has been approved for remnant ablation only, patients who cannot achieve sufficient elevation of TSH might need rhTSH injection for treatment of distant metastasis.…”

Section: Possible Factors For Dose Determinationmentioning

confidence: 99%

“…Short-term side effects (such as nausea, neck pain, lacrimal gland dysfunction, salivary gland dysfunction, and altered tastes) in the weeks following RAI remnant ablation have been reported to be more frequent in patients treated with 3.7 GBq as compared to 1.1 GBq in recent multi-center [5,48] Postoperative thyroglobulin [50,51] Status and methods of TSH stimulation [52][53][54] Low-iodine diet [55,56] Age [2,57] RAI radioactive iodine randomized trials [10,11]. As most of the short-term side effects are reversible and can be managed with the attention of physicians, the long-term irreversible adverse effects of RAI ablation including secondary primary malignancy, xerostomia, and infertility should be more carefully considered [45].…”

Section: Adverse Effects and Dose Of Raimentioning

confidence: 99%

Factors Associated with Dose Determination of Radioactive Iodine Therapy for Differentiated Thyroid Cancer

Hong

Ahn

2018

Nucl Med Mol Imaging

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Radioactive iodine (RAI) therapy for differentiated thyroid cancer has been successfully used for more than 70 years. However, there is still plenty of controversy surrounding the use and doses of radioiodine. There is insufficient evidence to answer the questions. Recent American Thyroid Association (ATA) guidelines seem to favor low-dose RAI, based on recent clinical trials and meta-analyses. However, long-term follow-up data remains limited, and there are additional factors we should consider that might affect the efficacy of RAI therapy. Therefore, until sufficient data are available, it is necessary to remain cautious about determining RAI doses by considering multiple patient-specific variables.

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“…Differentiated thyroid cancer has excellent prognosis compared to other malignancies, and this is partly related to the successful treatment of unresectable distant metastasis by therapeutic dose of I-131 administration. However, two-thirds of patients with distant metastases ultimately become radioiodine refractory disease [ 6 , 7 , 11 , 20 , 24 – 26 ]. The radioiodine refractory status is related to decreased expression of the NIS and diminished targeting of NIS to the membrane of cancer cells or both [ 26 , 27 ].…”

Section: Radioiodine Treatment Coupled With Redifferentiation For mentioning

confidence: 99%

Personalized Medicine Based on Theranostic Radioiodine Molecular Imaging for Differentiated Thyroid Cancer

Ahn

2016

BioMed Research International

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Molecular imaging based personalized therapy has been a fascinating concept for individualized therapeutic strategy, which is able to attain the highest efficacy and reduce adverse effects in certain patients. Theranostics, which integrates diagnostic testing to detect molecular targets for particular therapeutic modalities, is one of the key technologies that contribute to the success of personalized medicine. Although the term “theranostics” was used after the second millennium, its basic principle was applied more than 70 years ago in the field of thyroidology with radioiodine molecular imaging. Differentiated thyroid cancer, which arises from follicular cells in the thyroid, is the most common endocrine malignancy, and theranostic radioiodine has been successfully applied to diagnose and treat differentiated thyroid cancer, the applications of which were included in the guidelines published by various thyroid or nuclear medicine societies. Through better pathophysiologic understanding of thyroid cancer and advancements in nuclear technologies, theranostic radioiodine contributes more to modern tailored personalized management by providing high therapeutic effect and by avoiding significant adverse effects in differentiated thyroid cancer. This review details the inception of theranostic radioiodine and recent radioiodine applications for differentiated thyroid cancer management as a prototype of personalized medicine based on molecular imaging.

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Analysis of Clinical Factors for the Determination of Optimal Serum Level of Thyrotropin After Recombinant Human Thyroid-Stimulating Hormone Administration

Cited by 9 publications

References 26 publications

Risk factors for radioactive iodine-avid metastatic lymph nodes on post I-131 ablation SPECT/CT in low- or intermediate-risk groups of papillary thyroid cancer

Risk factors for radioactive iodine-avid metastatic lymph nodes on post I-131 ablation SPECT/CT in low- or intermediate-risk groups of papillary thyroid cancer

Factors Associated with Dose Determination of Radioactive Iodine Therapy for Differentiated Thyroid Cancer

Personalized Medicine Based on Theranostic Radioiodine Molecular Imaging for Differentiated Thyroid Cancer

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