Thyroid hormone replacement one day before 131I therapy in patients with well-differentiated thyroid cancer

Document Type : Original Article


Department of Nuclear Medicine, Kanazawa University Hospital, Japan


Objective(s): The current study aimed to determine the efficacy of radioiodine-131 (131I) ablation therapy with thyroid hormone replacement one day before 131I administration in patients with well-differentiated thyroid cancer (DTC).
Methods: This retrospective study included 29 patients who underwent 131I therapies twice for DTC during 6-12 months.  Since all the patients obviously had residual lesions by their serum thymoglobulin levels or their scintigrams at the first therapies, they underwent the second 131I therapies without diagnostic scintigraphy after the first therapies. After confirming the sufficient elevation of TSH concentration, thyroid hormone replacement was resumed one day before 131I administration (3.7-7.4GBq).  The ablation rate of thyroid remnant at the first 131I therapy was evaluated by comparing 131I post-therapeutic images of the two treatments.
Results: Three patients were administrated thyroid hormone after 131I therapy because of insufficient TSH concentration under thyroid hormone withdrawal. In the remaining 26 patients, 41 thyroid remnant accumulations were detected in all 26 patients at the first 131I therapy. Based on the second 131I post-therapeutic images, successful ablation was confirmed in 24 of 26 patients (92.3%) and 38 of 41 sites (92.7%), which was comparable with historically reported ablation rates.
Conclusion: Thyroid hormone replacement one day before 131I therapy could provide a sufficiently high ablation rate in patients with DTC.


  1. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009 Nov;19(11):1167-214.
  2. Sawka AM, Thephamongkhol K, Brouwers M, Thabane L, Browman G, Gerstein HC. Clinical review 170: A systematic review and metaanalysis of the effectiveness of radioactive iodine remnant ablation for well-differentiated thyroid cancer. J Clin Endocrinol Metab. 2004 Aug;89(8):3668-76.
  3. Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med. 1998 Jan 29;338(5):297-306.
  4. Luster M, Clarke SE, Dietlein M, Lassmann M, Lind P, Oyen WJ, et al. Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2008 Oct;35(10):1941-59.
  5. Meier DA, Brill DR, Becker DV, Clarke SE, Silberstein EB, Royal HD, et al. Procedure guideline for therapy of thyroid disease with (131)iodine. J Nucl Med. 2002 Jun;43(6):856-61.
  6. Kim EY, Kim TY, Kim WG, Yim JH, Han JM, Ryu JS, et al. Effects of different doses of radioactive iodine for remnant ablation on successful ablation and on long-term recurrences in patients with differentiated thyroid carcinoma. Nucl Med Commun. 2011 Oct;32(10):954-9.
  7. Cherk MH, Kalff V, Yap KS, Bailey M, Topliss D, Kelly MJ. Incidence of radiation thyroiditis and thyroid remnant ablation success rates following 1110 MBq (30 mCi) and 3700 MBq (100 mCi) post-surgical 131I ablation therapy for differentiated thyroid carcinoma. Clin Endocrinol (Oxf). 2008 Dec;69(6):957-62.
  8. Hackshaw A, Harmer C, Mallick U, Haq M, Franklyn JA. 131I activity for remnant ablation in patients with differentiated thyroid cancer: A systematic review. J Clin Endocrinol Metab. 2007 Jan;92(1):28-38.
  9. de Klerk JM, de Keizer B, Zelissen PM, Lips CM, Koppeschaar HP. Fixed dosage of 131I for remnant ablation in patients with differentiated thyroid carcinoma without pre-ablative diagnostic 131I scintigraphy. Nucl Med Commun. 2000 Jun;21(6):529-32.
  10. Cailleux AF, Baudin E, Travagli JP, Ricard M, Schlumberger M. Is diagnostic iodine-131 scanning useful after total thyroid ablation for differentiated thyroid cancer? J Clin Endocrinol Metab. 2000 Jan;85(1):175-8.
  11. Dow KH, Ferrell BR, Anello C. Quality-of-life changes in patients with thyroid cancer after withdrawal of thyroid hormone therapy. Thyroid. 1997 Aug;7(4):613-9.
  12. Lee J, Yun MJ, Nam KH, Chung WY, Soh EY, Park CS. Quality of life and effectiveness comparisons of thyroxine withdrawal, triiodothyronine withdrawal, and recombinant thyroid-stimulating hormone administration for low-dose radioiodine remnant ablation of differentiated thyroid carcinoma. Thyroid. 2010 Feb;20(2):173-9.
  13. Taieb D, Sebag F, Cherenko M, Baumstarck-Barrau K, Fortanier C, Farman-Ara B, et al. Quality of life changes and clinical outcomes in thyroid cancer patients undergoing radioiodine remnant ablation (RRA) with recombinant human TSH (rhTSH): a randomized controlled study. Clin Endocrinol (Oxf). 2009 Jul;71(1):115-23.
  14. Luster M, Lippi F, Jarzab B, Perros P, Lassmann M, Reiners C, et al. rhTSH-aided radioiodine ablation and treatment of differentiated thyroid carcinoma: a comprehensive review. Endocr Relat Cancer. 2005 Mar;12(1):49-64.
  15. Pacini F, Ladenson PW, Schlumberger M, Driedger A, Luster M, Kloos RT, et al. Radioiodine ablation of thyroid remnants after preparation with recombinant human thyrotropin in differentiated thyroid carcinoma: results of an international, randomized, controlled study. J Clin Endocrinol Metab. 2006 Mar;91(3):926-32.
  16. Sanchez R, Espinosa-de-los-Monteros AL, Mendoza V, Brea E, Hernandez I, Sosa E, et al. Adequate thyroid-stimulating hormone levels after levothyroxine discontinuation in the follow-up of patients with well-differentiated thyroid carcinoma. Arch Med Res. 2002 Sep-Oct;33(5):478-81.
  17. Grigsby PW, Siegel BA, Bekker S, Clutter WE, Moley JF. Preparation of patients with thyroid cancer for 131I scintigraphy or therapy by 1-3 weeks of thyroxine discontinuation. J Nucl Med. 2004 Apr;45(4):567-70.
  18. McLaughlin CM, Hunter SJ, Bell PM, McCance DR, Sheridan B, Atkinson AB. Conventional withdrawal of thyroid hormone before radioiodine therapy in differentiated thyroid carcinoma: how frequently are adequately raised TSH levels attained? Clin Endocrinol (Oxf). 2008 Jul;69(1):169-70.
  19. Serhal DI, Nasrallah MP, Arafah BM. Rapid rise in serum thyrotropin concentrations after thyroidectomy or withdrawal of suppressive thyroxine therapy in preparation for radioactive iodine administration to patients with differentiated thyroid cancer. J Clin Endocrinol Metab. 2004 Jul;89(7):3285-9.
  20. Liel Y. Preparation for radioactive iodine administration in differentiated thyroid cancer patients. Clin Endocrinol (Oxf). 2002 Oct;57(4):523-7.