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Serial TSH Determination after T₃ Withdrawal or Thyroidectomy in the Therapy of Thyroid Carcinoma

Tucson Medical Center, University of Arizona Health Sciences Center, St. Mary's Hospital, and St. Joseph's Hospital, Tucson, Arizona

Correspondence: For reprints contact: S. V. Hilts, P.O. Box 42615, Tucson, AZ 85733.

ABSTRACT

Exogenous triiodothyronine (T₃) was substituted for levothyroxin or desiccated thyroid in 13 athyrotic patients previously treated for papillary, follicular, or mixed papillary-follicular carcinoma of the thyroid. After 4 weeks, T₃ therapy was discontinued and serial determinations of plasma thyroid stimulating hormone (TSH) concentrations were made. A roughly exponential rise in TSH values, corresponding to a doubling time of 2 days, was observed until a level of 40 µIU/ml was reached, after which the curve passed through a maximum at 20 days. The mean time required for a level of 50 µIU/ml was 11 days, and this time is suggested for TSH determination before I-131 imaging of patients with thyroid cancer. Plasma TSH values in eight patients following "total" thyroidectomy showed a much slower and more variable rise, with a mean doubling time of 7.6 days. Weekly TSH levels beginning at 15 days will provide a rational basis for I-131 imaging in this group, in whom a longer period of hypothyroidism will be required before imaging and therapy. Adherence to these protocols should minimize the duration of hypothyroidism in patients undergoing I-131 treatment of thyroid carcinoma.

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