Abstract
BackgroundLarge multinodular goiter (MNG) in elderly people is a common finding which can require intervention. The long-term effect of radioiodine therapy on thyroid volume (TV) and function after recombinant human (rh) TSH pre-treatment was evaluated.MethodsAfter baseline evaluation, 40 subjects over 60 years old with a large MNG were treated with 131I up to the activity of 600 MBq. Nineteen patients were pretreated with rhTSH (0.1 mg on 2 consecutive days; group 1) while 21 subjects underwent treatment without rhTSH pretreatment (group 2). TV was monitored every 6–12 months by ultrasonography. The median follow-up period was 36 months.ResultsAt the baseline, the groups matched in terms of TV, 24-h radioiodine uptake (RAIU), urinary iodine and neck complaints. The number of subjects pretreated with anti-thyroid drugs was significantly (P = 0.01) greater in group 2 than in group 1; TSH was more suppressed (P = 0.003) and f-T3 was more elevated (P = 0.005) in group 2 than in group 1 patients. RhTSH increased 24-h RAIU in group 1 up to the baseline level observed in group 2. The 131I activity administered was similar in both groups. Adverse events were slight and similar in both groups. A permanent post-radioiodine toxic condition was reported only in 2 patients in group 2. After radioiodine therapy, hypothyroidism was observed in significantly more group 1 patients than group 2 patients (P = 0.002). While TV was reduced in both groups, the percentage TV reduction recorded at the last examination was significantly higher (P = 0.03) in group 1 than in group 2. MNG-related complaints were significantly reduced in both group 1 (P = 0.0001 vs baseline) and group 2 (P = 0.001) patients.ConclusionLow radioiodine activities after pretreatment with low-dosage rhTSH are able to reduce TV and improve MNG-related symptoms in elderly subjects.
Highlights
Large multinodular goiter (MNG) in elderly people is a common finding which can require intervention
While the functional activity of MNG is variable, in elderly subjects TSH sometimes declines as a consequence of autonomous hormonal activity of the nodules, with clinical features ranging from euthyroidism to sub-clinical or overt hyperthyroidism
We report the long-term outcome of a larger group of elderly out-patients with large MNG treated with weighted 131I activities up to 600 MBq after pre-treatment with two consecutive 0.1 mg Recombinant human TSH (rhTSH) doses
Summary
Large multinodular goiter (MNG) in elderly people is a common finding which can require intervention. While the functional activity of MNG is variable, in elderly subjects TSH sometimes declines as a consequence of autonomous hormonal activity of the nodules, with clinical features ranging from euthyroidism to sub-clinical or overt hyperthyroidism. In these patients, surgery is the standard procedure but it may be contraindicated because of cardiac, pulmonary, or other chronic disorders. When surgery is not practicable or is refused by the patient, radioiodine (RAI) therapy may be used to reduce thyroid volume (TV) in enlarged MNG [2,3,4,5]; the rather low RAI uptake (RAIU) and the need for intense RAI activity can make this therapeutic procedure less effective
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