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Endogenous TSH levels at the time of 131I ablation do not influence ablation success, recurrence-free survival or differentiated thyroid cancer-related mortality

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Based on a single older study it is established dogma that TSH levels should be ≥30 mU/l at the time of postoperative 131I ablation in differentiated thyroid cancer (DTC) patients. We sought to determine whether endogenous TSH levels, i.e. after levothyroxine withdrawal, at the time of ablation influence ablation success rates, recurrence-free survival and DTC-related mortality.

Methods

A total of 1,873 patients without distant metastases referred for postoperative adjuvant 131I therapy were retrospectively included from 1991 onwards. Successful ablation was defined as stimulated Tg <1 μg/l.

Results

Age, gender and the presence of lymph node metastases were independent determinants of TSH levels at the time of ablation. TSH levels were not significantly related to ablation success rates (p = 0.34), recurrence-free survival (p = 0.29) or DTC -elated mortality (p = 0.82), but established risk factors such as T-stage, lymph node metastases and age were. Ablation was successful in 230 of 275 patients (83.6 %) with TSH <30 mU/l and in 1,359 of 1,598 patients (85.0 %) with TSH ≥30 mU/l. The difference was not significant (p = 0.55). Of the whole group of 1,873 patients, 21 had recurrent disease. There were no significant differences in recurrence rates between patients with TSH <30 mU/l and TSH ≥30 mU/l (p = 0.16). Ten of the 1,873 patients died of DTC. There were no significant differences in DTC-specific survival between patients with TSH <30 mU/l and TSH ≥30 mU/l (p = 0.53).

Conclusion

The precise endogenous TSH levels at the time of 131I ablation are not related to the ablation success rates, recurrence free survival and DTC related mortality. The established dogma that TSH levels need to be ≥30 mU/l at the time of 131I ablation can be discarded.

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Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital Münster, Münster, Germany

    Alexis Vrachimis & Burkhard Riemann

  2. Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany

    Uwe Mäder, Christoph Reiners & Frederik A. Verburg

  3. Department of Nuclear Medicine, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany

    Frederik A. Verburg

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  1. Alexis Vrachimis
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Correspondence to Frederik A. Verburg.

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Conflicts of interest

Frederik A. Verburg has in the past accepted consultancy fees from Roche and is a consultant to Bayer. The other authors have nothing to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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The present study was a retrospective one; for this type of study formal consent is not required.

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Vrachimis, A., Riemann, B., Mäder, U. et al. Endogenous TSH levels at the time of 131I ablation do not influence ablation success, recurrence-free survival or differentiated thyroid cancer-related mortality. Eur J Nucl Med Mol Imaging 43, 224–231 (2016). https://doi.org/10.1007/s00259-015-3223-2

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  • DOI: https://doi.org/10.1007/s00259-015-3223-2

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