Pre-Radioiodine Thyrotropin Thresholds During Withdrawal Preparation in Differentiated Thyroid Cancer after Total Thyroidectomy: A Systematic Review and Meta-Analysis
Authors' conclusion
The current evidence base is insufficient to support or refute the routine use of a specific TSH threshold before RAI administration. These findings question the recommendation to achieve TSH ≥30 mIU/L before RAI and highlight the need for trials to define the minimal effective level of TSH stimulation.
Study context
- Population
- Adults with differentiated thyroid cancer (DTC) prepared for radioiodine (RAI) by thyroid hormone withdrawal (THW); 68.5% women, mean age 46 years
- Participants
- 4,651 adults8 retrospective cohort studies
- Comparison
- Higher vs lower pre-RAI TSH thresholds during THW preparation
- Outcome
- Disease-specific mortality, recurrence and response to therapy
Methodological detailsrandom-effects models, CLARITY risk of bias, GRADE certainty of evidence, Searches of MEDLINE, Embase, Cochrane and Scopus, inception to March 2025
- Random-effects models
- CLARITY risk of bias
- GRADE certainty of evidence
- Searches of MEDLINE, Embase, Cochrane and Scopus, inception to March 2025
Pooled result
As reported in the abstract
Oncologic outcomes by pre-RAI TSH threshold (≥30 vs <30 mIU/L) · 2- and 3-year follow-up
Estimate (CI)
Between TSH ≥30 mIU/L and TSH <30 mIU/L
pooled RR (excellent response) 0.87(0.68–1.11)
Between TSH ≥30 mIU/L and TSH <30 mIU/L
RR (indeterminate response) 1.28(0.72–2.27)
- Recurrence rates did not differ (RR; CI)
- RR = 1.45; CI 0.83-2.55
Original publication
Pre-Radioiodine Thyrotropin Thresholds During Withdrawal Preparation in Differentiated Thyroid Cancer after Total Thyroidectomy: A Systematic Review and Meta-Analysis. Thyroid. Published 11 February 2026. doi:10.
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