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Previous Volume 337:888-896 September 25, 1997 Number 13 Next

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ABSTRACT

Background To detect recurrent disease in patients who have had differentiated thyroid cancer, periodic withdrawal of thyroid hormone therapy may be required to raise serum thyrotropin concentrations to stimulate thyroid tissue so that radioiodine (iodine-131) scanning can be performed. However, withdrawal of thyroid hormone therapy causes hypothyroidism. Administration of recombinant human thyrotropin stimulates thyroid tissue without requiring the discontinuation of thyroid hormone therapy.

Methods One hundred twenty-seven patients with thyroid cancer underwent whole-body radioiodine scanning by two techniques: first after receiving two doses of thyrotropin while thyroid hormone therapy was continued, and second after the withdrawal of thyroid hormone therapy. The scans were evaluated by reviewers unaware of the conditions of scanning. The serum thyroglobulin concentrations and the prevalence of symptoms of hypothyroidism and mood disorders were also determined.

Results Sixty-two of the 127 patients had positive whole-body radioiodine scans by one or both techniques. The scans obtained after stimulation with thyrotropin were equivalent to the scans obtained after withdrawal of thyroid hormone in 41 of these patients (66 percent), superior in 3 (5 percent), and inferior in 18 (29 percent). When the 65 patients with concordant negative scans were included, the two scans were equivalent in 106 patients (83 percent). Eight patients (13 percent of those with at least one positive scan) were treated with radioiodine on the basis of superior scans done after withdrawal of thyroid hormone. Serum thyroglobulin concentrations increased in 15 of 35 tested patients: 14 after withdrawal of thyroid hormone and 13 after administration of thyrotropin. Patients had more symptoms of hypothyroidism (P<0.001) and dysphoric mood states (P<0.001) after withdrawal of thyroid hormone than after administration of thyrotropin.

Conclusions Thyrotropin stimulates radioiodine uptake for scanning in patients with thyroid cancer, but the sensitivity of scanning after the administration of thyrotropin is less than that after the withdrawal of thyroid hormone. Thyrotropin scanning is associated with fewer symptoms and dysphoric mood states.

Source Information

From the Division of Endocrinology and Metabolism and the Thyroid Tumor Center, Johns Hopkins University School of Medicine, Baltimore (P.W.L.); the Division of Endocrinology and Metabolism, University of Massachusetts Medical Center, Worcester (L.E.B.); the Department of Internal Medicine, Ohio State University, Columbus (E.L.M.); the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Md. (F.B.-D., B.D.W.); the Division of Endocrinology and Metabolism, Sinai Hospital of Baltimore, Baltimore (D.S.C.); the Division of Endocrinology and Metabolism (J.R.G.) and the Thyroid Unit (F.E.W.), Beth Israel Hospital, Boston; the Division of Endocrinology and Metabolism, Mount Sinai Medical Center, New York (T.F.D.); the Thyroid Study Unit, University of Chicago Medical Center, Chicago (L.J.D.); and the Thyroid Unit, Massachusetts General Hospital, Boston (G.H.D., D.S.R.). Other authors were Ian D. Hay, M.D., Ph.D. (Division of Endocrinology, Mayo Clinic and Foundation, Rochester, Minn.), Silvina Levis, M.D. (Division of Endocrinology, University of Miami School of Medicine, Miami), James C. Reynolds, M.D. (National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md.), Jacob Robbins, M.D. (National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md.), David V. Becker, M.D. (New York Hospital, Cornell Medical Center, New York), Ralph R. Cavalieri, M.D. (Veterans Affairs Medical Center, San Francisco), Harry R. Maxon, M.D. (University of Cincinnati Medical Center, Cincinnati), Kevin McEllin (Genzyme Corporation, Cambridge, Mass.), and Richard Moscicki, M.D. (Genzyme Corporation, Cambridge, Mass.).

Address reprint requests to Dr. Ladenson at the Division of Endocrinology and Metabolism, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287-4904.

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