Large doses of radioiodione were administered since 1969 to 15 euthyroid patients with compressive voluminous goitres. A decrease in goitre size was observed in all patients (between 15 and 63%, average 39%). Maximal effect on goitre size was attained rapidly, partially already after less than one year and was almost maximal after 24 to 30 months. No significant local adverse reactions were observed; no patient required steroid administration. Hypothyroidism followed radioiodine administration in 30% of the patients after 2 years; after 8 years, all those who had survived were hypothyroid, requiring substitution therapy. In all patients there was a marked improvement in compression symptoms. The use of radioactive iodine therapy constitutes an alternative to surgery in selected patients with large compressive goitres in whom surgery is contraindicated because of age or other medical conditions. The therapeutic administration of radioiodine has now gained large acceptance throughout the world for the management of hyperthyroidism (1-3). In this clinical condition, it is assumed that radioiodine induces radiation damage to the thyroid follicular cells, leading to impaired replication and eventu¬ ally to reduction in the size of the thyroid (4). Rad¬ ioiodine therapy is, however, also employed in other clinical conditions, such as treatment of mé¬ tastases from thyroid differentiated cancer and ab¬ lation of cervical remnants after incomplete surgery for thyroid cancer. It is therefore apparent that thyroid tissue mass can be reduced by admin¬ istration of radioiodine. Hence, this tool may be applicable to euthyroid patients with multinodular goitre who present local compression symptoms.In the present article we report on the retrospec¬ tive results of radioiodine administration over a period of 20 years in a group of inoperable euthy¬ roid patients with voluminous multinodular goitre. These elderly patients were considered inoperable for reasons related to their age and/or associated medical disease, or because they refused surgery (and in some cases because surgeons refused to op¬ erate on them). The patients required therapy be¬ cause of recent increase in goitre size, respiratory distress symptoms due to trachéal compression, and in rare instances because of discomfort related to dysphagia.
Patients and MethodsA group of 15 patients (11 females and 4 males), aged 62 to 86 years, were treated since 1969. It is noteworthy that 9 of 15 patients (mean age 67 years) were treated between 1969 and 1978, but only 6 patients (mean age 76 years) after 1978. The higher mean age of patients during the latter decade indicates that during recent years older pa¬ tients were more frequently referred to surgery. All pa¬ tients had a multinodular goitre, in most instances asym¬ metrical and with variable degrees of substernal exten¬ sion. Goitre had been present since many years (some¬ times decades) and was most frequently stable in size. In some patients hormone substitution therapy had been given previously for long periods o...
Serum levels of T4 T3, and TSH and peak TSH after TRH administration were determined in 60 female subjects affected with asymptomatic autoimmune thyroiditis (AAT), in 27 normal subjects, and in 8 myxoedematous patients used as controls. The AAT subjects were divided into 3 groups on the basis of their basal and peak TSH values. In the first group (grade I AAT), these parameters were similar to those of the normal controls; in the second (grade II AAT), basal TSH remained normal but peak TSH was significantly increased; and in the third (grade III AAT), both parameters were significantly increased. Serum T4 levels decreased progressively from group 1 to group 3, but all T4 values were within the normal range. T3 levels were similar in all groups. Peak and basal TSH values were highly correlated, except in grade II AAT. There seems to exist a graded process of subclinical hypothyroidism in AAT; a progressive pituitary TSH reserve is modulated by a progressive decrease in T4 levels still within the normal range.
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