Robbins Richard J, Larson Steven M, Sinha Naina, Shaha Ashok, Divgi Chaitanya, Pentlow Keith S, Ghossein Ronald, Tuttle R Michael
Endocrinology Service, Department of Medicine, Memorial Hospital for Cancer and Allied Diseases, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
J Nucl Med. 2002 Nov;43(11):1482-8.
Radioiodine remnant ablation (RRA) is frequently used after a thyroidectomy for differentiated thyroid carcinoma because it has been reported to reduce the number of local recurrences and to increase overall survival. Although the traditional method of preparation for RRA is thyroid hormone withdrawal, several physicians at our medical center have offered the option of having RRA after preparation by recombinant human thyroid-stimulating hormone (thyrotropin; TSH) over the past 2 y. During this same time period, other patients at our center were prepared for RRA by hormone withdrawal.
We took this opportunity to retrospectively review the rate of complete remnant ablation in patients having RRA after hormone withdrawal compared with those having RRA after recombinant human TSH. Only patients who had RRA after January 1, 1999, and follow-up diagnostic studies at our medical center, were included in the analysis. A successful ablation was defined as no visible radioiodine uptake on the follow-up diagnostic scans, performed with 185 MBq (5 mCi) (131)I. The 2 groups had comparable patient and tumor characteristics and received similar ablative activities of (131)I.
We found that 84% of those prepared by recombinant human TSH, and 81% of those prepared by hormone withdrawal, had complete resolution of visible thyroid bed uptake after RRA (P = not significant).
Given the biases that exist in retrospective studies, we cannot yet recommend RRA preparation by recombinant human TSH for routine use. However, these preliminary findings are favorable enough to support the design of a prospective randomized trial comparing RRA success rates after preparation by either thyroid hormone withdrawal or recombinant human TSH.
放射性碘残留消融（RRA）常用于分化型甲状腺癌甲状腺切除术后，因为据报道它可减少局部复发数量并提高总生存率。虽然RRA的传统准备方法是甲状腺激素撤停，但在过去两年里，我们医疗中心的几位医生提供了通过重组人促甲状腺激素（促甲状腺素；TSH）进行准备后进行RRA的选择。在同一时期，我们中心的其他患者通过激素撤停为RRA做准备。
我们借此机会回顾性比较了通过激素撤停进行RRA的患者与通过重组人TSH进行RRA的患者的完全残留消融率。仅纳入了1999年1月1日之后在我们医疗中心进行RRA并接受后续诊断检查的患者。成功消融定义为在使用185 MBq（5 mCi）（131）I进行的后续诊断扫描中无可见放射性碘摄取。两组患者和肿瘤特征相当，接受的（131）I消融活度相似。
我们发现，通过重组人TSH准备的患者中有84%，通过激素撤停准备的患者中有81%，在RRA后甲状腺床摄取可见部分完全消退（P = 无显著性差异）。
鉴于回顾性研究中存在的偏差，我们目前还不能推荐将通过重组人TSH进行RRA准备用于常规使用。然而，这些初步结果足够有利，足以支持设计一项前瞻性随机试验，比较通过甲状腺激素撤停或重组人TSH进行准备后的RRA成功率。
