Abstract
Purpose
Renal radioiodine excretion is ~50% faster during euthyroidism versus hypothyroidism. We therefore sought to assess lesion dose/GBq of administered 131I activity (LDpA) in iodine-avid metastases (IAM) of differentiated thyroid carcinoma (DTC) in athyreotic patients after recombinant human thyroid-stimulating hormone (rhTSH) versus after thyroid hormone withdrawal (THW).
Methods
We retrospectively compared mean LDpA between groups of consecutive patients (N = 63) receiving 124I positron emission tomography/computed tomography (124I PET/CT) aided by rhTSH (n = 27) or THW (n = 36); we prospectively compared LDpA after these stimulation methods within another individual. Data derived from serial PET scans and one CT scan performed 2–96 h post-124I ingestion. A mixed model analysis of covariance (ANCOVA) calculated the treatment groups’ mean LDpAs adjusting for statistically significant baseline intergroup differences: non-IAM were more prevalent, median IAM count/patient lower in cervical lymph nodes and higher in distant sites, median stimulated thyroglobulin higher, mean cumulative radioiodine activity greater and prior diagnostic scintigraphy more frequent in the rhTSH patients.
Results
Mean LDpAs were: rhTSH group (n = 71 IAM), 30.6 Gy/GBq; THW group (n = 66 IAM), 51.8 Gy/GBq. The difference in group means (rhTSH less THW), −21.2 Gy/GBq, was statistically non-significant (p = 0.1667). However, the 95% confidence interval of that difference (−51.4 to + 9 Gy/GBq) suggested a trend favouring THW. The within-patient comparison found 2.9- to 10-fold higher LDpAs under THW.
Conclusion
We found some suggestions, but no statistically significant evidence, that rhTSH administration results in a lower radiation dose to DTC metastases than does THW. A large, well-controlled, prospective within-patient study should resolve this issue.
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Acknowledgments
LSF and TP have received speakers’ fees and RJM fees for editorial/logistical assistance on prior rhTSH-related papers from Genzyme Corporation, the rhTSH manufacturer. The University of Essen and MHH Departments of Nuclear Medicine received grants from Genzyme supporting 124I PET/CT data analysis in general, and the prospective in-patient comparison reported in this paper, respectively.
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Freudenberg, L.S., Jentzen, W., Petrich, T. et al. Lesion dose in differentiated thyroid carcinoma metastases after rhTSH or thyroid hormone withdrawal: 124I PET/CT dosimetric comparisons. Eur J Nucl Med Mol Imaging 37, 2267–2276 (2010). https://doi.org/10.1007/s00259-010-1565-3
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DOI: https://doi.org/10.1007/s00259-010-1565-3