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
. 2013:2013:769473.
doi: 10.1155/2013/769473. Epub 2013 Jul 9.

Long-term results after treatment of very low-, low-, and high-risk thyroid cancers in a combined setting of thyroidectomy and radio ablation therapy in euthyroidism

Affiliations

Long-term results after treatment of very low-, low-, and high-risk thyroid cancers in a combined setting of thyroidectomy and radio ablation therapy in euthyroidism

Nikos Emmanouilidis et al. Int J Endocrinol. 2013.

Abstract

Introduction. Differentiated thyroid cancer treatment usually consists of thyroidectomy and radio ablation in hypothyroidism 4-6 weeks after surgery. Replacing hypothyroidism by recombinant human thyroid stimulating hormone can facilitate radio ablation in euthyroidism within one week after surgery. The outcome of this approach was investigated. Methods. This is a prospective randomized trial to compare thyroidectomy and radio ablation within a few days after preconditioning with recombinant human thyroid stimulating hormone versus thyroidectomy and radio ablation separated by four weeks of L-T4 withdrawal. Tumors were graded into very low-, low- , or high-risk tumors. Recurrence-free survival was confirmed at follow-up controls by neck ultrasound and serum thyroglobulin. Suspected tumor recurrence was treated by additional radio ablation or surgery. Quality-of-life questionnaires with additional evaluation of job performance and sick-leave time were used in all patients. Results. Radio ablation in euthyroidism in quick succession after thyroidectomy did not lead to higher tumor recurrence rates of differentiated thyroid cancers in any risk category and was significantly advantageous with respect to quality-of-life (P < 0.001), sick-leave time (P < 0.001), and job performance (P = 0.002). Conclusion. Recombinant human thyroid stimulating hormone can be used safely and with good efficacy to allow radio ablation under sustained euthyroidism within one week after thyroidectomy.

PubMed Disclaimer

Figures

Figure 1
Figure 1
DTC-recurrence and patient survival.  Statistically there was no significant difference in numbers of suspected DTC recurrences in (a) low/very low and (b) high-risk DTC categories as well (Log Rank P = 0.317; Log Rank P = 0.761, resp.). (c)  Histological evidence (lymph node and bone metastasis) for DTC recurrence was found only in one case. (d) There was no difference in patient survival (Log Rank P = 0.299). One patient of the hypothyroidism group died due to natural cause. Prior to death this patient had neither a suspected nor histological proven DTC recurrence.
Figure 2
Figure 2
Symptoms of hypothyroidism.  Comparison of clinical symptoms for rhTSH receivers versus hypothyroidism patients by comparison of average points per category and patient. RhTSH patients had significantly fewer symptoms in comparison to standard protocol patients (P < 0.0001, Mann-Whitney U test).

References

    1. Mazzaferri EL. An overview of the management of papillary and follicular thyroid carcinoma. Thyroid. 1999;9(5):421–427. - PubMed
    1. Schlumberger MJ. Papillary and follicular thyroid carcinoma. The New England Journal of Medicine. 1998;338(5):297–306. - PubMed
    1. DeGroot LJ, Kaplan EL, McCormick M, Straus FH. Natural history, treatment, and course of papillary thyroid carcinoma. Journal of Clinical Endocrinology and Metabolism. 1990;71(2):414–424. - PubMed
    1. Sweeney DC, Johnston GS. Radioiodine therapy for thyroid cancer. Endocrinology and Metabolism Clinics of North America. 1995;24(4):803–839. - PubMed
    1. Dow KH, Ferrell BR, Anello C. Quality-of-life changes in patients with thyroid cancer after withdrawal of thyroid hormone therapy. Thyroid. 1997;7(4):613–619. - PubMed

LinkOut - more resources