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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 12/2010

01-12-2010 | Original Article

Lesion dose in differentiated thyroid carcinoma metastases after rhTSH or thyroid hormone withdrawal: 124I PET/CT dosimetric comparisons

Authors: Lutz Stefan Freudenberg, Walter Jentzen, Thorsten Petrich, Cornelia Frömke, Robert J. Marlowe, Till Heusner, Wolfgang Brandau, Wolfram H. Knapp, Andreas Bockisch

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 12/2010

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Abstract

Purpose

Renal radioiodine excretion is ~50% faster during euthyroidism versus hypothyroidism. We therefore sought to assess lesion dose/GBq of administered 131I activity (LDpA) in iodine-avid metastases (IAM) of differentiated thyroid carcinoma (DTC) in athyreotic patients after recombinant human thyroid-stimulating hormone (rhTSH) versus after thyroid hormone withdrawal (THW).

Methods

We retrospectively compared mean LDpA between groups of consecutive patients (N = 63) receiving 124I positron emission tomography/computed tomography (124I PET/CT) aided by rhTSH (n = 27) or THW (n = 36); we prospectively compared LDpA after these stimulation methods within another individual. Data derived from serial PET scans and one CT scan performed 2–96 h post-124I ingestion. A mixed model analysis of covariance (ANCOVA) calculated the treatment groups’ mean LDpAs adjusting for statistically significant baseline intergroup differences: non-IAM were more prevalent, median IAM count/patient lower in cervical lymph nodes and higher in distant sites, median stimulated thyroglobulin higher, mean cumulative radioiodine activity greater and prior diagnostic scintigraphy more frequent in the rhTSH patients.

Results

Mean LDpAs were: rhTSH group (n = 71 IAM), 30.6 Gy/GBq; THW group (n = 66 IAM), 51.8 Gy/GBq. The difference in group means (rhTSH less THW), −21.2 Gy/GBq, was statistically non-significant (p = 0.1667). However, the 95% confidence interval of that difference (−51.4 to  + 9 Gy/GBq) suggested a trend favouring THW. The within-patient comparison found 2.9- to 10-fold higher LDpAs under THW.

Conclusion

We found some suggestions, but no statistically significant evidence, that rhTSH administration results in a lower radiation dose to DTC metastases than does THW. A large, well-controlled, prospective within-patient study should resolve this issue.
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Metadata
Title
Lesion dose in differentiated thyroid carcinoma metastases after rhTSH or thyroid hormone withdrawal: 124I PET/CT dosimetric comparisons
Authors
Lutz Stefan Freudenberg
Walter Jentzen
Thorsten Petrich
Cornelia Frömke
Robert J. Marlowe
Till Heusner
Wolfgang Brandau
Wolfram H. Knapp
Andreas Bockisch
Publication date
01-12-2010
Publisher
Springer-Verlag
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 12/2010
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-010-1565-3

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