Radioactive Iodine Administered for Thyroid Remnant Ablation Following Recombinant Human Thyroid Stimulating Hormone Preparation Also Has an Important Adjuvant Therapy Function

Tuttle, R. Michael; López, Norma; Leboeuf, Rébecca; Minkowitz, Shaye M.; Grewal, Ravinder K.; Brokhin, Matvey; Omry, Gal; Larson, S. M.

doi:10.1089/thy.2009.0401

Cited by 59 publications

(36 citation statements)

References 11 publications

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“…Our findings confirm those of previous retrospective studies [4,20,39,40], showing the rates of ablation success and disease outcome associated with rhTSH therapy to be statistically similar or even superior to the rates achieved with THW before ablation in DTC patients who had initially had an intermediate or high risk of recurrence.…”

Section: Discussionsupporting

confidence: 90%

Recombinant Human Thyroid-Stimulating Hormone-Aided Remnant Ablation Achieves a Response to Treatment Comparable to That with Thyroid Hormone Withdrawal in Patients with Clinically Relevant Lymph Node Metastases

2014

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It has already been shown that remnant ablation in patients with thyroid cancer and lymph node (LN) metastases has similar results when patients are prepared after recombinant human thyroid-stimulating hormone (rhTSH) therapy or thyroid hormone withdrawal (THW). Due to the current changes in the risk-of-recurrence classifications, we decided to evaluate the initial response to treatment and the outcome at medium-term follow-up in 40 consecutive patients with clinically relevant lymph nodes who received radioiodine remnant ablation after rhTSH therapy (n = 20) or THW (n = 20). Each patient received either 100 or 150 mCi 131-I for ablation based on TNM status, and the mean amounts of 131-I used in the 2 groups were not significantly different. An excellent response to treatment was observed in 45% of the patients prepared after rhTSH therapy compared to 20% of those prepared after THW (p = 0.08). Three patients (2 in the THW group and 1 in the rhTSH group) who had N1a in the initial surgery presented with structural persistence as an initial response to treatment. One patient in the THW group had a follow-up of the persistent disease with no surgical treatment, and 2 others received a lateral LN dissection. When the status at final follow-up was considered (median follow-up 3.3 years, range 3-4.2), 60% of the patients ablated after rhTSH therapy were considered with no evidence of disease, compared to 30% of those who underwent THW. The frequency of structural persistence (metastatic LN) was similar in the 2 groups (15 vs. 25%), and the distribution of the responses at final follow-up was not statistically significantly different (p = 0.12). We conclude that preparation after rhTSH therapy seems to be as effective as after THW for patients with clinically relevant LN metastases.

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Section: Discussionsupporting

confidence: 90%

Recombinant Human Thyroid-Stimulating Hormone-Aided Remnant Ablation Achieves a Response to Treatment Comparable to That with Thyroid Hormone Withdrawal in Patients with Clinically Relevant Lymph Node Metastases

2014

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“…The three goals of post-surgical RAI therapy in patients with differentiated DTC are enumerated by Tuttle et al (2010): i) to ablate residual normal thyroid tissue that may facilitate surveillance. ii) As 'adjuvant therapy' because of the potential tumoricidal effect on residual microscopic RAI-avid disease.…”

Section: Purposes Of Post-surgical Rai Therapymentioning

confidence: 99%

“…It is likely that more of these patients were in the 100 mCi group rather than the 30 mCi group as higher doses are more likely to demonstrate an abnormal focus of activity on a post-RxWBS (Tuttle et al 2010).…”

Section: Rai Dose Controversy In Initial Treatment Of the Low-risk Pamentioning

confidence: 99%

“…Accordingly, the validity of this approach is unestablished, stressing the need for prospective trials that would confirm or refute these criteria and in order to firmly establish the clinical management that would minimize the risk of recurrent DTC. These authors' proposed arbitrary criteria defining significant node metastasis could under-stage up to 20% of DTC patients, as discussed above (Tuttle et al 2010).…”

Section: Recent Trends Recommending No Post-operative Rai Ablation Inmentioning

confidence: 99%

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Current controversies in the initial post-surgical radioactive iodine therapy for thyroid cancer: a narrative review

Blumhardt¹,

Wolin²,

Phillips³

et al. 2014

Endocrine-Related Cancer

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Differentiated thyroid cancer (DTC) is the most common endocrine malignancy and the fifth most common cancer in women. DTC therapy requires a multimodal approach, including surgery, which is beyond the scope of this paper. However, for over 50 years, the postoperative management of the DTC post-thyroidectomy patient has included radioactive iodine (RAI) ablation and/or therapy. Before 2000, a typical RAI post-operative dose recommendation was 100 mCi for remnant ablation, 150 mCi for locoregional nodal disease, and 175-200 mCi for distant metastases. Recent recommendations have been made to decrease the dose in order to limit the perceived adverse effects of RAI including salivary gland dysfunction and inducing secondary primary malignancies. A significant controversy has thus arisen regarding the use of RAI, particularly in the management of the low-risk DTC patient. This debate includes the definition of the low-risk patient, RAI dose selection, and whether or not RAI is needed in all patients. To allow the reader to form an opinion regarding post-operative RAI therapy in DTC, a literature review of the risks and benefits is presented.

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“…rhTSH-assisted RAI ablative therapy is associated with similar rates of persistent disease and clinical recurrences than those observed after traditional THW preparation, at least in the short-term follow-up [6,7]. In addition, preparation with either rhTSH or THW appears to have similar adjuvant effects on small-volume RAI-avid disease identified outside the thyroid bed at the time of initial RAI ablation [4,8]. …”

mentioning

confidence: 99%

Radioactive Iodine Activities for Postsurgical Thyroid Ablation: The Lower the Better

Pacini

2012

Eur Thyroid J

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Radioactive Iodine Administered for Thyroid Remnant Ablation Following Recombinant Human Thyroid Stimulating Hormone Preparation Also Has an Important Adjuvant Therapy Function

Abstract: Preparation with either rhTSH or THW in this retrospective study appears to have similar therapeutic (tumoricidal) effects on small volume RAI-avid metastatic disease incidentally discovered at the time of ablation in both locoregional lymph nodes and pulmonary parenchyma.

Cited by 59 publications

References 11 publications

Recombinant Human Thyroid-Stimulating Hormone-Aided Remnant Ablation Achieves a Response to Treatment Comparable to That with Thyroid Hormone Withdrawal in Patients with Clinically Relevant Lymph Node Metastases

Recombinant Human Thyroid-Stimulating Hormone-Aided Remnant Ablation Achieves a Response to Treatment Comparable to That with Thyroid Hormone Withdrawal in Patients with Clinically Relevant Lymph Node Metastases

Current controversies in the initial post-surgical radioactive iodine therapy for thyroid cancer: a narrative review

Radioactive Iodine Activities for Postsurgical Thyroid Ablation: The Lower the Better

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