Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2010 Nov 10;2010(11):CD008302.
doi: 10.1002/14651858.CD008302.pub2.

Recombinant human thyrotropin (rhTSH) aided radioiodine treatment for residual or metastatic differentiated thyroid cancer

Chao Ma  1 , Jiawei Xie, Wanxia Liu, Guoming Wang, Shuyao Zuo, Xufu Wang, Fengyu Wu
Affiliations
Meta-Analysis

Recombinant human thyrotropin (rhTSH) aided radioiodine treatment for residual or metastatic differentiated thyroid cancer

Chao Ma et al. Cochrane Database Syst Rev. .

Abstract

Background: For patients with differentiated thyroid cancer (DTC) following thyroidectomy, thyroid hormone withdrawal (THW) for four to six weeks has been used for decades to increase serum thyroid-stimulating hormone (TSH) concentrations in order to enhance iodine-131 uptake by normal thyroid cells and differentiated thyroid tumour cells. Exogenous stimulation with recombinant human thyroid-stimulating hormone (rhTSH) offers an alternative to THW while avoiding the morbidity of hypothyroidism. However, the efficacy of rhTSH-aided iodine-131 treatment for residual or metastatic DTC has not been prospectively assessed.

Objectives: To assess the effects of rhTSH-aided radioiodine treatment for normal residual or metastatic DTC.

Search strategy: We obtained studies from computerised searches of MEDLINE, EMBASE and The Cochrane Library (all until November 2009), and paper collections of conferences held in Chinese.

Selection criteria: Randomised controlled clinical trials and quasi-randomised controlled clinical trials comparing the effects of rhTSH with THW on iodine-131 treatment for residual or metastatic differentiated thyroid cancer with at least six months of follow up.

Data collection and analysis: Two authors independently assessed risk of bias and extracted data.

Main results: Altogether 223 patients with DTC participated in four trials. Overall, studies had a high risk of bias. We found no statistically significant differences between rhTSH and THW treatment in terms of successful ablation rate but significant benefits in radiation exposure to blood and bone marrow. One trial reported on benefits in some domains of health-related quality of life. There were no deaths and no serious adverse effects in DTC patients treated with either rhTSH or THW. Maximum follow up was 12 months. None of the included trials investigated complete or partial remission of metastatic tumour, secondary malignancies or economic outcomes. We did not find sufficient data comparing rhTSH with THW-aided radioiodine treatment for metastatic DTC.

Authors' conclusions: Results from four randomised controlled clinical trials suggest that rhTSH is as effective as THW on iodine-131 thyroid remnant ablation, with limited data on significant benefits in decreased whole body radiation exposure and health-related quality of life. It is still uncertain whether lower iodine-131 doses (1110 MBq or 1850 MBq versus 3700 MBq) are equally effective for remnant ablation under rhTSH stimulation. Randomised controlled clinical trials are needed to guide treatment selection for metastatic differentiated thyroid cancer.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

Figure 1
Figure 1
Adapted PRISMA (preferred reporting items for systematic reviews and meta‐analyses) flow‐chart of study selection
Figure 2
Figure 2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Figure 3
Figure 3
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Analysis 1.1
Analysis 1.1
Comparison 1 Primary outcomes, Outcome 1 Successful ablation rate.
Analysis 1.2
Analysis 1.2
Comparison 1 Primary outcomes, Outcome 2 Ablation by 1850 MBq vs 3700 MBq iodine‐131 under rhTSH stimulation.
Analysis 2.1
Analysis 2.1
Comparison 2 Secondary outcomes, Outcome 1 Health‐related quality of life.
Analysis 2.2
Analysis 2.2
Comparison 2 Secondary outcomes, Outcome 2 Radiation exposure to blood and bone marrow.
Analysis 2.3
Analysis 2.3
Comparison 2 Secondary outcomes, Outcome 3 Adverse events.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD008302

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

    1. Chianelli M, Todino V, Graziano FM, Panunzi C, Pace D, Guglielmi R, et al. 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. European Journal of Endocrinology 2009;160(3):431‐6. - PubMed
    1. Hanscheid H, Lassmann M, Luster M, Thomas SR, Pacini F, Ceccarelli C, et al. Iodine bio‐kinetics and dosimetry in radioiodine therapy of thyroid cancer: procedures and results of a prospective international controlled study of ablation after rhTSH or hormone withdrawal. Journal of Nuclear Medicine 2006;47:648‐54. - PubMed
    2. Mernagh P, Campbell S, Dietlein M, Luster M, Mazzaferri E, Weston AR. Cost‐effectiveness of using recombinant human TSH prior to radioiodine ablation for thyroid cancer, compared with treating patients in a hypothyroid state: the German perspective. European Journal of Endocrinology 2006;155:405‐14. - PubMed
    3. Pacini F, Ladenson PW, Schlumberger M, Driedger A, Luster M, Kloos RT, et al. Radioiodine ablation of thyroid remnants after preparation with recombinant human thyrotropin in differentiated thyroid carcinoma: results of an international, randomized, controlled study. Journal of Clinical Endocrinology and Metabolism 2006;91(3):926‐32. - PubMed
    1. Pilli T, Brianzoni E, Capoccetti F, Castagna MG, Fattori S, Poggiu A, et al. A comparison of 1850 (50 mCi) and 3700 MBq (100 mCi) 131‐iodine administered doses for recombinant thyrotropin‐stimulated postoperative thyroid remnant ablation in differentiated thyroid cancer. Journal of Clinical Endocrinology and Metabolism 2007;92(9):3542‐6. - PubMed
    1. Vaiano A, Claudio T, Boni G, Grosso, M, Lazzeri P, Colato C, et al. Comparison between remnant and red‐marrow absorbed dose in thyroid cancer patients submitted to 131I ablative therapy after rh‐TSH stimulation versus hypothyroidism induced by L‐thyroxine withdrawal. Nuclear Medicine Communications 2007;28(3):215‐23. - PubMed

References to studies excluded from this review

    1. Barbaro D, Boni G, Meucci G, Simi U, Lapi P, Orsini P, et al. Recombinant human thyroid‐stimulating hormone is effective for radioiodine ablation of post‐surgical thyroid remnants. Nuclear Medicine Communications 2006;27:627‐32. - PubMed
    1. Borget I, Remy H, Chevalier J, Ricard M, Allyn M, Schlumberger M, et al. Length and cost of hospital stay of radioiodine ablation in thyroid cancer patients: comparison between preparation with thyroid hormone withdrawal and thyrogen. European Journal of Nuclear Medicine and Molecular Imaging 2008;35:1457‐63. - PubMed
    1. Duntas LH, Biondi B. Short‐term hypothyroidism after levothyroxine‐withdrawal in patients with differentiated thyroid cancer: clinical and quality of life consequences. European Journal of Endocrinology 2007;156:13. - PubMed
    1. Jarzab B, Handkiewicz‐Junak D, Roskosz J, Puch Z, Wygoda Z, Kukulska A, et al. Recombinant human TSH‐aided radioiodine treatment of advanced differentiated thyroid cancer: single‐center study of 54 patients. European Journal of Nuclear Medicine and Molecular Imaging 2003;30:1077‐86. - PubMed
    1. Luster M, Lassmann M, Haenscheid H, Michalowski U, Incerti C, Reiners C. Use of recombinant human thyrotropin before radioiodine therapy in patients with advanced differentiated thyroid carcinoma. Journal of Clinical Endocrinology and Metabolism 2000;85:3640‐5. - PubMed

Additional references

    1. Adler ML, Macapinlac HA, Robbins RJ. Radioiodine treatment of thyroid cancer with the aid of recombinant human thyrotropin. Endocrine Practice 1998;4:282‐6. - PubMed
    1. Aslam SN, Daly RG. Use of recombinant human thyrotropin in a complicated case of metastatic papillary thyroid carcinoma. Endocrine Practice 2001;7:99‐101. - PubMed
    1. Barbaro D, Boni G, Meucci G, Simi U, Lapi P, Orsini P, et al. Radioiodine treatment with 30 mCi after recombinant human thyrotropin stimulation in thyroid cancer: effectiveness for postsurgical remnants ablation and possible role of iodine content in L‐thyroxine in the outcome of ablation. Journal of Clinical Endocrinology and Metabolism 2003;88:4110‐5. - PubMed
    1. Berg G, Lindstedt G, Suurkü la M, Jansson S. Radioiodine ablation and therapy in differentiated thyroid cancer under stimulation with recombinant human thyroid‐stimulating hormone (rhTSH). Journal of Endocrinological Investigation 2002;25:44‐52. - PubMed
    1. Bohuslavizki KH, Klutmann S, Bleckmann C, Brenner W, Lassmann S, Mester J, et al. Salivary gland protection by amifostine in high‐dose radioiodine therapy of differentiated thyroid cancer. Strahlentherapie und Onkologie 1999;175:57‐61. - PubMed

MeSH terms