Abstract
Aim: Withdrawal of levothyroxine with resultant hypothyroidism is still used in preparation
for I-131 diagnostic whole-body scan (DWBS) and thyroglobulin (TG)-measurement in
patients afflicted with differentiated thyroid cancer (DTC). Recombinant human thyroid-stimulating
hormone (rhTSH) enhances TSH stimulation obviating the clinical and economical consequences
of hypothyroidism. Primary aim of this study was an intraindividual comparison of
diagnostic follow-up measurements under these two sets of conditions by taking clinical
and socio-economic parameters into account. Second aim was to determine a clear patient
preference for the one method or the other.
Methods: This non-interventional observational study included patients (n=192 signed informed
consent, n=128 protocol compliant patients without need for therapeutic intervention)
with DTC first treated by thyroidectomy and radioiodine ablation. Control visits including
I-131 DWBS were planned at 3–6 months post-thyroidectomy after a phase (KU 1) of thyroid
hormone withdrawal (THW) and again after 6–12 months later in a euthyroid state under
exogenous stimulation with rhTSH (KU 2). Study design was open, prospective and multicentric.
Data collected consisted of patient information (SF-12® Health Survey), thyroid-specific results of clinical examinations and several aspects
of daily life, e. g., employment, days of absence from work and other economic aspects.
Results: In contrast to KU 1, in KU 2 there is a highly significant improvement (p<0.0001)
in all studied clinical symptoms and aspects of managing daily life. A significant
increase of the SF-12® health survey score could also be identified. Mental score showed a higher increase
than physical score. Included patients were less absent from work before KU 2, (absent
4.5%, median 4 days in euthyroid state [range 2–5 d]), vs. before KU 1 (absent 47.8%,
median 10 days in hypothyroid state [range 1–30 d]). After KU 2 7.7% of the euthyroid
patients was absent from work (median 5 days) while 37.5% was after KU 1 (median 6
days).
Conclusion: Included patients benefited subjectively and objectively from the use of rhTSH for
diagnostic procedures in the treatment of DTC. A clear preference (127 of 128) of
analyzed patients could be identified for exogenous stimulation with rhTSH.
Key words
rhTSH - thyroid cancer - hypothyroidism - diagnostic whole body
References
Correspondence
dueren_c@klinik.uni-wuerzburg.de
