Jandee Lee

BACKGROUND: Few reports have examined the use of recombinant human thyroid-stimulating hormone (rhTSH) for ablation of postsurgical thyroid remnants after low-dose radioactive iodine (RI) therapy, compared with conventional thyroid hormone withdrawal. We investigated whether patient preparation using rhTSH was comparable to conventional thyroid hormone withdrawal with respect to efficacy of postsurgical remnant ablation in low-risk patients receiving a 30 mCi RI. In addition, we also evaluated the impact of rhTSH (rhTSH vs. conventional thyroid hormone withdrawal) on quality of life (QoL) of thyroid cancer patients undergoing RI ablation. METHODS: This study included three groups of patients, enrolled consecutively. From February 2006 to March 2007, 291 patients were enrolled and randomized, after total thyroidectomy: (1) withdrawal of levothyroxine (LT4) for 4 weeks (T4-WD Group, n = 89), (2) withdrawal of LT4 for 4 weeks plus 2 weeks on and then 2 weeks off liothyronine (LT3) (T3-WD Group, n = 133), and (3) rhTSH administration (rhTSH Group, n = 69). QoL was determined at the time of ablation. RESULTS: Patients in the three groups did not differ significantly in baseline characteristics or tumor, node and metastasis (TNM) staging. In all study groups, serum TSH levels showed very good stimulation (mean, 82.24 +/- 18.21 mU/L), without significant between-group differences (p = 0.5213). Follow-up examinations were performed 12 months after ablation to assess ablation outcome in each group by 131 whole body scans (WBSs), serum thyroglobulin measurement after TSH stimulation, and neck ultrasonography. The successful ablation rate was 91.0% in T4-WD Group, 91.7% in T3-WD Group, and 91.3% in rhTSH Group, without significant between-preparation differences (p = 0.2061). QoL was better preserved in rhTSH Group than in T4-WD and T3-WD Groups (p < 0.0001). However, there was no QoL difference at the time of ablation between T4-WD and T3-WD Groups. CONCLUSIONS: Our study indicates that use of rhTSH preserves QoL in patients undergoing RI ablation and affords an ablation success rate comparable to that seen after thyroid hormone withdrawal. Notably, ablation preparation using withdrawal of LT3 for 2 weeks did not prevent development of profound hypothyroidism, as also occurred when LT4 alone was withdrawn for 4 weeks.

OBJECTIVES: Robotic total thyroidectomy (TT) with modified radical neck dissection (MRND) using a gasless transaxillary approach has been reported safe and effective in patients with N1b papillary thyroid carcinoma (PTC), with notable cosmetic benefits when compared with conventional open TT. We have compared oncological outcomes and quality of life (QoL) in PTC patients undergoing robotic TT and MRND and those undergoing conventional open procedures. MATERIALS AND METHODS: Between March 2010 and July 2011, 128 patients with PTC and lateral neck node metastases underwent TT with MRND, including 62 who underwent robotic and 66 who underwent open TT. We compared oncologic outcomes and safety as well as functional outcomes such as postoperative subjective voice and swallowing difficulties. We also evaluated neck pain, sensory changes, and cosmetic satisfaction after surgery using various QoL symptom scales. Neck and shoulder disability was assessed using arm abduction tests (AAT) and questions from the neck dissection impairment index (NDII). RESULTS: Although the mean operating time was significantly longer in the robotic (mean, 271.8 ± 50.2 min) than in the open group (mean, 208.9 ± 56.3 min) (P < .0001), postoperative complication rates and oncologic outcomes, including the results of radioactive iodine scans and postoperative serum Tg concentrations, did not differ significantly. Subjective voice outcomes and postoperative AAT and neck dissection impairment index were also similar, but postoperative swallowing difficulties (P = .0041) and sensory changes (P < .0001) were significantly more frequent in the open than in the robotic group. In particular, mean cosmetic satisfaction score was significantly higher in the robotic than in the open group (P < .0001). CONCLUSIONS: Robotic TT with MRND yielded similar oncologic outcomes and safety as conventional open procedures, with similar recovery of neck and shoulder disability. However, the robot technique resulted in better QoL outcomes, including better cosmetic results and reductions in neck sensory changes and swallowing discomfort.

OBJECTIVES: Distant metastasis (DM) is seldom observed at initial presentation of differentiated thyroid carcinoma (DTC), making it difficult to assess the clinical characteristics and treatment outcomes of DTC patients with DM. We therefore retrospectively assessed these parameters in DTC patients who presented with DM between July 1994 and December 2007. In addition, we compared biologic behaviors and prognostic factors between patients presenting with DM and those developing DM after initial treatment. METHODS: Among 1560 DTC patients who underwent thyroidectomies during the 13.5-year study period, 91 patients were included in this study; 52 patients (3.4%) displayed DM at initial presentation and 39 (2.5%) developed DM after initial 131 radiacitive iodine (RI) treatment. Metastatic lesions were treated with high dose RI (94.5%), surgical resection (14.3%), external beam radiation therapy (31.9%), embolization of feeding vessels (1.1%), and/or chemotherapy (1.1%). Median duration of follow-up was 75 months (range, 12-158 months). RESULTS: Mean patient age was 57 years (range, 13-80 years), and the female-to-male ratio was 2.03:1. Metastases were detected in the lung only (68.1%), bone only (16.5%), and multiple sites (15.4%). When clinical and tumor characteristics were considered, metastatic lesion iodine avidity was significantly higher in patients presenting with DM. At 5 and 10 years, the overall survival (OS) rates in patients presenting with DM were 83.8% and 72.1%, respectively, and the disease-specific survival (DSS) rates were 68.5% and 26.8%. OS did not differ significantly between patients presenting with DM and those developing DM after initial treatment. However, those with initial DM enjoyed significantly improved DSS compared with patients who developed DM after initial treatment. At last follow-up, 22 patients (24.2%) were alive without disease, 48 (52.7%) were alive with disease, and 21 (23.1%) had died of disease in study patients. Multivariate Cox's regression analyses showed that complete local control was a significant predictor of OS and DSS in all study patients. In patients developing DM after initial treatment, metastatic lesion iodine avidity was also associated with both OS and DSS. In contrast, avidity was associated only with DSS in patients presenting with DM. CONCLUSIONS: Our study showed that DTC patients presenting with initial DM appear to have relatively favorable outcomes compared with DTC patients who developed DM after initial treatment. Complete local control may be the most important prognostic indicator in all DM patients. Metastatic lesion iodine avidity had a significant impact on both OS and DSS in patients developing DM after initial treatment, but significantly influenced only DSS in patients presenting with initial DM.