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DOI: 10.1530/EJE-08-0641
European Journal of Endocrinology, Vol 161, Issue 5, 763-769
Copyright © 2009 by European Society of Endocrinology
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CLINICAL STUDY

Surgery and radioablation therapy combined: introducing a 1-week-condensed procedure bonding total thyroidectomy and radioablation therapy with recombinant human TSH

Nikos Emmanouilidis1, Jörg A Müller2, Mark D Jäger1, Stephan Kaaden1, Fabian A Helfritz1, Zeynep Güner1, Holger Kespohl1, Wolfgang Knitsch1, Wolfram H Knapp2, Jürgen Klempnauer1 and Georg F W Scheumann1

1 , Klinik für Viszeral- und Transplantationschirurgie2 Klinik für Nuklearmedizin, Medizinische Hochschule Hannover, Carl-Neuberg Straße 1, Rudolf-Pichlmayr Transplantations-Forschungszentrum, OE 6220, D-30625 Hannover, Germany

(Correspondence should be addressed to N Emmanouilidis; Email: emmanouilidis.nikos{at}mh-hannover.de)

Objective: The objective of this study was to determine whether the use of recombinant human TSH (rhTSH) to stimulate radioiodine uptake after thyroidectomy is as efficacious as a period of withholding thyroid hormones, while at the same time avoiding hypothyroidism, reducing sick leave time and shortening the hospital stay.

Design: Our aim was to compare the standard procedure of differentiated thyroid cancer treatment, which consists of thyroidectomy followed by 4 weeks of hypothyroidism and a conclusive ablative activity of 131iodine, with a new shortened treatment in which L-thyroxine (T4) medication is initiated a day after thyroidectomy, followed by application of rhTSH stimulation and subsequent ablation a few days after surgery. We presumed our treatment to represent the most sophisticated strategy for the reduction in sick leave days overall without any reduction in safety or the efficacy of ablative therapy.

Methods: Patients (n=25) were randomized either for surgery and rhTSH stimulation or surgery and L-T4 abstinence before the first application of radioiodine. Ablation success was determined by neck ultrasound and serum thyroglobulin during follow-up. RhTSH receivers were monitored for an average of 635 days (S.D.±289) and patients in L-T4 abstinence for an average of 624 days (S.D.±205). Both groups were statistically compared for significant differences in treatment efficacy, safety and overall time of sick leave.

Results and conclusions: Our shortened treatment proved to be equally efficacious and safe in comparison with the conventional therapy regimen. At the same time, it showed economic advantages through the reduction in average sick leave time from ~29 days (L-T4 abstinence) down to ~6 days (rhTSH stimulation) as well as sustaining the patient's quality of life by the complete avoidance of hypothyroidism.






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