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Low-activity (2.0 GBq; 54 mCi) radioiodine post-surgical remnant ablation in thyroid cancer: comparison between hormone withdrawal and use of rhTSH in low-risk patients

¹ Nuclear Medicine Unit, Department of Diagnostics, Regina Apostolorum Hospital, Via San Francesco 50, 00041 Albano, Rome, Italy² Department of Nuclear Medicine and Molecular Imaging, UMCG, University of Groningen, Groningen, The Netherlands³ Endocrinology Unit, Department of Metabolic and Digestive Diseases, Regina Apostolorum Hospital, Albano, Rome, Italy⁴ Department of Nuclear Medicine, S. Andrea Hospital, ‘Sapienza’ University, Rome, Italy

(Correspondence should be addressed to M Chianelli; Email: marcochianelli{at}libero.it)

Objective: (a) To compare the efficacy of low-activity (2 GBq; 54 mCi) ¹³¹I ablation using L-thyroxine withdrawal or rhTSH stimulation, and (b) to assess the influence of thyroid remnants volume on the ablation rate.

Design: Patients underwent neck ultrasound, ¹³¹I neck scintigraphy and radioiodine uptake. Post-therapy whole body scan (WBS) was acquired after 4–6 days. Ablation was assessed after 6–12 months by WBS, Tg and TgAb following L-thyroxine withdrawal.

Methods: Group A: preparation by L-T₄ withdrawal (37 days); 21 patients received ¹³¹I (2.02±0.22 GBq; 54.6±5.9 mCi) and on the day of treatment, TSH, Tg, TgAb were measured; Group B: stimulation by rhTSH; 21 patients received ¹³¹I (1.97±0.18 GBq; 53.2±4.9 mCi) 24 h after the second injection of rhTSH (0.9 mg) and TSH, Tg and TgAb were measured after 2 days.

Results: At follow-up, 90.0% of patients from group A and 85.0% of patients from group B had Tg levels <1 ng/ml; no uptake was observed in 95.2% and in 90.5% of patients from group A or B respectively, with no statistical differences for both ablation criteria. Before ¹³¹I treatment, small thyroid remnants (<1 ml) were detected by US in <25% of all patients.

Conclusions: The use of rhTSH for the preparation of low-risk patients to ablation therapy with low activities of ¹³¹I (2 GBq; 54 mCi) is safe and effective and avoids hypothyroidism. The presence of thyroid remnants smaller than 1 ml at US evaluation had no effect on the ablation rate.

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