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Abdulhameed NM, Janabi MA. Evaluating the Effectiveness of Triiodothyronine Suppression and Withdrawal Versus Thyrogen Injections in Thyroid Cancer Assessments. Cureus 2023; 15:e51061. [PMID: 38269223 PMCID: PMC10806585 DOI: 10.7759/cureus.51061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2023] [Indexed: 01/26/2024] Open
Abstract
Objective This study aimed to evaluate the specificity and effectiveness of triiodothyronine (T3) suppression and withdrawal, as compared to the conventional diagnostic approach using Thyrogen recombinant thyroid-stimulating hormone (TSH) injections, in the assessment of thyroid cancer patients post-thyroidectomy. Methods In this retrospective study, 18 patients diagnosed with thyroid cancer at a tertiary care hospital (Mediclinic City Hospital) in Dubai were included. The patients underwent total thyroidectomy, iodine ablation, and neck ultrasound. The cohort's clinical characteristics were analyzed, and histopathological examination of thyroid nodules was performed. In this study, paired T-tests were applied to evaluate the before-and-after impact of T3 and Thyrogen treatments on TSH and thyroglobulin (TG) levels in individual patients. To further analyze the effectiveness of these treatments, independent T-tests were conducted, allowing for a comparison of TSH and TG levels between different treatment groups within the patient cohort. This approach provided a comprehensive assessment of the treatments' effects on key thyroid indicators. Additionally, the diagnostic accuracy of T3 withdrawal and Thyrogen post-test on TG levels was assessed using statistical measures including sensitivity, specificity, and predictive values. Results The cohort had a mean age of 42.1 years and a female predominance. Distinct clinical profiles were observed across different thyroid cancer subtypes. Histopathological analysis confirmed typical features of papillary carcinoma variants. Significant changes in TSH levels post-treatment were noted, with T3 treatments showing a marked increase in TSH and TG levels, although changes in TG levels were not always statistically significant. Diagnostic test evaluation showed a sensitivity of 77.78%, a specificity of 83.33%, and an overall accuracy of 80.00% for T3 withdrawal and Thyrogen post-test on TG. Conclusion The study provides comprehensive insights into the clinical profiles and treatment responses in thyroid cancer patients post-thyroidectomy. The effectiveness of T3 and Thyrogen treatments in altering TSH and TG levels was established, with significant implications for patient management. The diagnostic tests for T3 withdrawal and Thyrogen post-test on TG demonstrated high accuracy, underlining their clinical utility in the post-treatment evaluation of thyroid cancer patients.
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Affiliation(s)
- Nada M Abdulhameed
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, ARE
| | - Mazin A Janabi
- Department of Nuclear Medicine, Mediclinic City Hospital, Dubai, ARE
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Tufekci D, Ayaz T, Sahin SB, Hocaoglu C. The "Non-Treated" Versus "LT3-Treated" Protocols of Short-Term Hypothyroidism Induction in Differentiated Thyroid Cancer: An Analysis of Hypothyroid Complications, Mood Disorders, and Quality of Life. Horm Metab Res 2023. [PMID: 37059443 DOI: 10.1055/a-2056-6073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
This study aimed to compare "non-treated" versus "levotriiodothyronine (LT3)-treated" protocols of short-term hypothyroidism induction prior to radioactive iodine (RAI) ablation therapy in differentiated thyroid cancer (DTC). A total of 120 DTC patients who had thyroxine withdrawal either via 4-week hypothyroidism induction (non-treated group, n=60) or 2-week administration and then 2-week withdrawal of LT3 (LT3-treated group, n=60) to induce hypothyroid state prior to RAI ablation after initial surgery were included. Complications related to hypothyroidism-induction, Beck Depression Inventory (BDI), Hospital Anxiety-Depression Scale (HADS), and SF-36 health-related quality of life (HRQoL) scores were recorded. In the non-treated group, transition from euthyroid to hypothyroid state was associated with significant increase in the likelihood of moderate-to-severe depression on BDI (p<0.001), presence of depression on HADS-D (p<0.001), presence of anxiety on HADS-A (6.7% during euthyroid state vs. 33.3% during hypothyroid state, p<0.001), and major syndrome on BPRS (0.0 vs. 10.0%, p=0.001) as well as significant decrease in all SF-36 HRQoL domain scores (p<0.001 for each). In conclusion, our findings indicate the likelihood of L3-treatment to enable a more favorable transition period from euthyroid to hypothyroid state without experiencing a deterioration in depression, anxiety, or HRQoL.
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Affiliation(s)
- Damla Tufekci
- Department of Endocrinology and Metabolism, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
| | - Teslime Ayaz
- Department of Internal Medicine, Recep Tayyip Erdoğan University, Faculty of Medicine, Rize, Turkey
| | - Serap Baydur Sahin
- Department of Endocrinology, Medistate Kavacık Hospital, Istanbul, Turkey
| | - Cicek Hocaoglu
- Department of Psychiatry, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
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Xiao J, Yun C, Cao J, Ding S, Shao C, Wang L, Huang F, Jia H. A pre-ablative thyroid-stimulating hormone with 30-70 mIU/L achieves better response to initial radioiodine remnant ablation in differentiated thyroid carcinoma patients. Sci Rep 2021; 11:1348. [PMID: 33446744 PMCID: PMC7809467 DOI: 10.1038/s41598-020-80015-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/29/2020] [Indexed: 11/12/2022] Open
Abstract
Our aim was to clarify the optimum pre-ablative thyroid-stimulating hormone (TSH) level for initial radioiodine remnant ablation (RRA) in patients with differentiated thyroid carcinoma (DTC). From December 2015 to May 2019, 689 patients undergone RRA at Nuclear Medicine Department, Second Hospital of Shandong University were included in the study. Patients were categorized by their pre-ablative TSH level grouping of < 30, 30–70 and ≥ 70 mIU/L. Response to RRA were evaluated as complete response (including excellent and indeterminate response) and incomplete response (including biochemical and structural incomplete response) after a follow-up of 6–8 months. Multivariable binary logistic regression model was used to explore the optimum pre-ablative TSH level range and independent factors associated with response to RRA. Rates of complete response to RRA were 63.04%, 74.59% and 66.41% in TSH level groups of < 30, 30–70 and ≥ 70 mIU/L, separately. With multivariate analysis, the study found that pre-ablative TSH levels, gender and lymph node dissection were independent predictors of response to RRA. TSH between 30 and 70 mIU/L had a higher rate of complete response compared with TSH < 30 mIU/L, OR 0.451 (95% CI 0.215–0.958, P = 0.036). A pre-ablative TSH level of 30–70 mIU/L was appropriate for patients with DTC to achieve a better response to RRA.
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Affiliation(s)
- Juan Xiao
- Center of Evidence-Based Medicine, Institute of Medical Sciences, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, China
| | - Canhua Yun
- Department of Nuclear Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jingjia Cao
- Department of Nuclear Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shouluan Ding
- Center of Evidence-Based Medicine, Institute of Medical Sciences, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, China
| | - Chunchun Shao
- Center of Evidence-Based Medicine, Institute of Medical Sciences, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, China
| | - Lina Wang
- Department of Laboratory Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fengyan Huang
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hongying Jia
- Center of Evidence-Based Medicine, Institute of Medical Sciences, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, China.
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Zheng W, Rui Z, Wang X, Li N, Tan J, Liu W. The Influences of TSH Stimulation Level, Stimulated Tg Level and Tg/TSH Ratio on the Therapeutic Effect of 131I Treatment in DTC Patients. Front Endocrinol (Lausanne) 2021; 12:601960. [PMID: 34177793 PMCID: PMC8232882 DOI: 10.3389/fendo.2021.601960] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 05/10/2021] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To study the influences of pre-ablation TSH stimulation level, sTg and sTg/TSH ratio on the therapeutic effect of the first 131I treatment in DTCs. METHODS According to the thyroid stimulating hormone (TSH) levels (mU/l), all the 479 differentiated thyroid cancer (DTC) patients were divided into two groups: TSH < 30 and TSH ≥ 30. The TSH ≥ 30 group was divided into three subgroups: 30 ≤ TSH < 60, 60 ≤ TSH < 90 and TSH ≥ 90. The clinical features and the therapeutic effects of the first 131I treatment were analyzed. The cutoffs of stimulated thyroglobulin (sTg) and sTg/TSH ratio were calculated to predict the therapeutic effect of 131I treatment. RESULTS Among the three subgroups, the TSH ≥ 90 subgroup was younger and less likely to be associated with cervical lymph node metastasis (LNM). The postoperative levothyroxine (L-T4) dose in the 60 ≤ TSH < 90 subgroup was the lowest. Between the two groups, patients in the TSH < 30 group had higher postoperative L-T4 dose and longer thyroid hormone withdrawal (THW) time. The excellent response rates six months after the first 131I treatment among the three subgroups and between the two groups were not of statistical significance. The distribution of different TSH stimulation levels among each response group was similar. The cutoffs for the better therapeutic effect of the first 131I treatment in sTg and sTg/TSH were < 9.51 ng/ml and < 0.11, respectively. Both univariate and multivariate logistic regressions showed that cervical LNM, distant metastasis, higher sTg and higher sTg/TSH ratio predicted poorer therapeutic effect. CONCLUSIONS There was no significant influence of TSH stimulation levels before the first 131I treatment on the therapeutic effect of DTC. The sTg/TSH ratio can be considered as another predictor of 131I therapeutic effect.
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Affiliation(s)
- Wei Zheng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
- *Correspondence: Wei Zheng,
| | - Zhongying Rui
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Xuan Wang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Ning Li
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Jian Tan
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Liu
- Department of Otolaryngology Head and Neck Surgery, Tianjin Fourth Central Hospital, Tianjin, China
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Tang CYL, Thang SP, Zaheer S, Kwan CK, Ng DCE. Recombinant human thyrotropin versus thyroid hormone withdrawal in an Asian population. Endocrine 2020; 69:126-132. [PMID: 32112240 DOI: 10.1007/s12020-020-02238-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/18/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT To prepare for radioactive iodine therapy in post total thyroidectomy patients with well-differentiated thyroid cancer (WDTC), either thyroid hormone withdrawal (THW) or administration of recombinant human thyrotropin (rhTSH) can be performed. OBJECTIVE Our objective is to compare quality of life (QoL) parameters using the SF-36v2 questionnaire (Short Form health survey) and a self-evaluated item, and the hypothyroid status using modified Billewicz scores in an Asian population undergoing either THW or rhTSH for remnant ablation or adjuvant treatment following total thyroidectomy for WDTC. We will also assess the proportion of patients achieving TSH level of >30 mU/L after 4 weeks of thyroid hormone withdrawal. RESULTS Patients in the rhTSH group were better in the QoL domains of physical functioning, role functioning/physical and bodily pain, while patients in THW group were better in mental health. This was however, not statistically significant. Modified Billewicz scores were higher in patients in THW group as compared with rhTSH group and statistically significant. A total of 96.3% of patients achieved TSH level >30 mU/L after 4 weeks of THW. CONCLUSION Clinical symptoms and signs of hypothyroidism as assessed with modified Billewicz scores were statistically significantly higher in the THW group. However, there was no statistically significant difference in QoL in the rhTSH group.
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Affiliation(s)
- Charlene Yu Lin Tang
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | - Sue Ping Thang
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Sumbul Zaheer
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Chung Kong Kwan
- Department of Oncology, United Christian Hospital, 130 Hip Wo St, Kwun Tong, Hong Kong
- Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - David Chee-Eng Ng
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Tamez-Perez HE, Delgadillo E, Soni-Duque D, Tamez-Peña AL. Strategy for radioiodine ablation in thyroid cancer with naïve levothyroxine patients. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.18.03942-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lawal IO, Vorster M, Ankrah AO, Sathekge MM. The optimal TSH level necessary for successful radioiodine ablation of differentiated thyroid carcinoma, as well as the time to reach this level, is a work in progress. Eur J Nucl Med Mol Imaging 2018; 45:1270-1271. [PMID: 29594409 DOI: 10.1007/s00259-018-3999-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 03/21/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Ismaheel O Lawal
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001, South Africa
| | - Mariza Vorster
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001, South Africa
| | - Alfred O Ankrah
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001, South Africa
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mike M Sathekge
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001, South Africa.
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