Evidence map›Paper›PMID 29460027›Full record

Trial reportEuropean journal of nuclear medicine and molecular imaging2018

Could short thyroid hormone withdrawal be an effective strategy for radioiodine remnant ablation in differentiated thyroid cancer patients?

Arnoldo Piccardo, Matteo Puntoni, Giulia Ferrarazzo, Luca Foppiani, Gianluca Bottoni, Vania Altrinetti, Giorgio Treglia, Mehrdad Naseri, Bassam Dib, Manlio Cabria and 3 more

Abstract readClinical Trial
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In one paragraph

Trial report in European journal of nuclear medicine and molecular imaging, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors.

Arnoldo PiccardoNuclear Medicine Department, Galliera Hospital, Genoa, Italy. arnoldo.piccardo@galliera.it.ORCID 0000-0002-6779-1471
Matteo PuntoniClinical Trial Unit, Office of the Scientific Director, Galliera Hospital, Genoa, Italy.
Giulia FerrarazzoNuclear Medicine Department, Galliera Hospital, Genoa, Italy.
Luca FoppianiInternal Medicine, Galliera Hospital, Genoa, Italy.
Gianluca BottoniNuclear Medicine Department, Galliera Hospital, Genoa, Italy.
Vania AltrinettiNuclear Medicine Department, Galliera Hospital, Genoa, Italy.
Giorgio TregliaDepartment of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
Mehrdad NaseriNuclear Medicine Department, Galliera Hospital, Genoa, Italy.
Bassam DibNuclear Medicine Department, Galliera Hospital, Genoa, Italy.
Manlio CabriaNuclear Medicine Department, Galliera Hospital, Genoa, Italy.
Pierpaolo TrimboliDepartment of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
Michela MassolloNuclear Medicine Department, Galliera Hospital, Genoa, Italy.
Luca GiovanellaDepartment of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeCurrent guidelines recommend thyroid hormone withdrawal (THW) of 3-4 weeks before radioiodine remnant ablation (RRA) of differentiated thyroid carcinoma (DTC). We aimed to evaluate (1) the reliability of a shorter THW (i.e., 14 days) to achieve adequate TSH levels (i.e., 30 mU/l), (2) the association between length of THW and response to therapy, and (3) the potential association between pre-ablation TSH levels and patients' outcome.

methodsAfter thyroidectomy, all patients started LT4 therapy, which was subsequently discontinued in order to perform RRA. Patients were broken down into two groups according to the length of THW: group A, 2 weeks of THW, and group B, 3-4 weeks of THW. We used clinical, biochemical, and imaging data to evaluate patients' outcome. By means of univariate and multivariate analysis, including main DTC prognostic factors, we assessed the impact of THW length and TSH levels on patients' outcome.

resultsWe evaluated 222 patients, 85 of whom were treated with RRA after a THW period of 2 weeks (group A). All other 137 patients underwent RRA after 3-4 weeks THW (group B). At the time of RRA all patients presented TSH levels ≥30 mU/l. After a median follow-up time of 3.4 years, we found 183 patients (82%) with excellent response to treatment and 39 patients (18%) showing incomplete response. Kaplan-Meier response to therapy curves showed that ablation-Tg, tumor size, and lymph node status were significantly associated with prognosis; no associations were found between THW length, TSH levels, and prognosis. Multivariate Cox model showed that only ablation-Tg was significantly associated with treatment response.

conclusionsPrior to RRA, a short 2-week THW is an effective method to stimulate TSH levels. No difference in terms of incomplete response to treatment was observed between DTC patients prepared for RRA with a short THW and those with the long THW.

Indexed as

Positron Emission Tomography Computed TomographyFemaleHumansIodine RadioisotopesItalyMaleMiddle AgedReproducibility of ResultsThyroidectomyThyroid HormonesThyroid NeoplasmsThyrotropinTreatment OutcomeIodine RadioisotopesThyroid HormonesThyrotropinDifferentiated thyroid cancerPrognosisRadioactive remnant ablationTSH stimulation

Identifiers

PMID29460027

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.