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June 11, 1982

Treatment of Recurrent Follicular Thyroid Carcinoma

JAMA. 1982;247(22):3081-3082. doi:10.1001/jama.1982.03320470029020

To the Editor.—  In a recent answer to the question of treatment of recurrent follicular thyroid carcinoma (1981;246:2376), Constance Pittman, MD, recommended an ablating dose of 120 to 150 mCi of sodium iodide I 131. Current literature indicates that a common cause of failure to respond to radioactive iodine is a treatment dose of less than 150 mCi.Dr Pittman recommends that replacement therapy of levothyroxine be withdrawn for at least one month and that the patient receive intramuscularly administered thyroidstimulating hormone (TSH), five units/day for three days.Hushman and Edwards1 have written:It has been demonstrated that endogenous TSH developed by leaving the postthyroidectomy patient off thyroid hormone for a minimum period of six weeks is better than the administration of endogenous TSH to a patient taking thyroid hormone. Off thyroid hormone, the serum TSH level rises without a plateau through 20 days to followup. The levels of endogenous