Reach further, in an Open Access Journal Endocrinology, Diabetes & Metabolism Case Reports

ISSN 1470-3947 (print)
ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology

Published by BioScientifica
Endocrine Abstracts (2007) 14 P326 

Partial withdrawal of levothyroxine to stimulate serum thyroglobulin (TG) in the follow-up of differentiated thyroid carcinoma (DTC)

Francesca Ianni, Carlo Antonio Rota, Salvatore Maria Corsello, Annapina De Rosa, Francesca Gallo, Rosa Maria Paragliola, Francesca Ingraudo, Maria Pia Ricciato, Maria Ludovica Maussier, Massimo Salvatori & Alfredo Pontecorvi

Author affiliations

Aim: We compared effectiveness of partial withdrawal of levothyroxine (L-T4) to the use of recombinant human TSH (rhTSH) in preparation for Tg testing. We also evaluated clinical aspects and quality-of-life (QOL) during both regimens.

Materials and methods: Ten consecutive patients, previously treated with total thyroidectomy and radioiodine ablation for DTC, underwent rhTSH protocol and, after 15 days, reduced their L-T4 dose by 50% for 5 weeks. At the fourth week TSH was tested (predictive cut-off >10 μUI/ml), and at the fifth week TSH and Tg were measured (cut-off TSH >25 μUI/ml). Patients who did not reach the last cut-off were asked to continue half-dose protocol and to repeat TSH and Tg dosage at the sixth week.

At baseline and at the end of both rhTSH and “half-dose” protocols, all patients filled out questionnaires for QOL (SF-36) and symptoms and signs of hypothyroidism (Zulewski score). The study was approved by local ethical committee.

Results: Adequate stimulation of Tg was obtained in all patients after rhTSH. At half-dose protocol, 5/10 patients had TSH >25 μUI/ml at the end of the fifth week and 2/10 attained cut-off at the end of the sixth week. One patient left the study, another patient had limited compliance because of depression, and the last one completely withdrew L-T4 to receive radioiodine treatment because of high stimulated-Tg levels although not attaining TSH cut-off.

Tg levels were slightly more sensitive in the partial withdrawal scheme than in the use of rhTSH, but without any statistically significant difference. During the partial withdrawal period 5/7 patients reported no disease-specific morbidity, while 2/7 had just minimal discomfort. On the SF-36 health survey no statistically significant differences were found.

Conclusion: Partial L-T4 withdrawal seems to be an effective, simple, economical and well-tolerated procedure for Tg stimulation during follow-up for DTC.

This Issue/Conference

Article tools

My recent searches