A Randomized Trial Comparing Levothyroxine with Radioactive Iodine in the Treatment of Sporadic Nontoxic Goiter

Abstract

A randomized clinical trial was performed in consecutive patients with sporadic nontoxic nodular goiter to compare efficacy and side effects of iodine-131 ((131)I) therapy with suppressive levothyroxine (L-thyroxine) treatment. Sixty-four patients were randomized after stratification for sex and menopausal age to receive (131)I (4.44 MBq/g thyroid; group A) or suppressive L-thyroxine treatment aiming at TSH values between 0.01 and 0.1 mU/L (group B). The main outcome measurements after 2 yr were goiter size by ultrasound, serum thyroid function tests, markers of bone turnover, and bone mineral density (BMD). Fifty-seven patients completed the trial. Goiter size was reduced after 2 yr by 44% in group A and by 1% in group B (P< 0.001). Nonresponders (goiter reduction <13%) were 1 of 29 patients in group A and 16 of 28 patients in group B (P = 0.00001). In responders, goiter reduction in group A (46%) was greater than in group B (22%; P< 0.005). In group A, 45% of patients developed hypothyroidism. In group B, 10 patients experienced thyrotoxic symptoms, requiring discontinuation of treatment in 2 (in 1 because of atrial fibrillation). Markers of bone formation and bone resorption increased significantly in group B, related to a mean decrease of 3.6% of BMD at the lumbar spine after 2 yr (from 1.09 +/- 0.22 to 1.05 +/- 0.23 g/cm(2); P< 0.001), both in pre- and postmenopausal women. No changes in BMD were observed in group A. In conclusion, (131)I therapy is more effective and better tolerated than L-thyroxine treatment in patients with sporadic nontoxic goiter. Suppressive L-thyroxine treatment results in significant bone loss.

An outline concerning the potential use of recombinant human thyrotropin for improving radioiodine therapy of multinodular goiter

“…Thyroid surgery and levothyroxine suppressive therapy are considered treatments of choice in several countries [2]. Levothyroxine suppressive therapy has been increasingly disfavored due to low efficacy and potential risks for bone loss and atrial fibrillation [3]. Surgery efficiently reduces the goiter size, but is associated with greater short-term morbidity than radioiodine ( 131 I) therapy [4].…”

“…The treatment of choice is usually thyroidectomy, but 131 I has been occasionally employed with significant reduction in thyroid volume and amelioration of symptoms and signs of compression. Data have consistently demonstrated that virtually all patients ultimately develop decrease in goiter size and improvement in compressive symptoms after therapy with 131 I [3,[5][6][7][8][9][10][11][12]. Studies have shown a mean thyroid volume reduction of *40% within the first year after 131 I therapy-mostly during the first 3 months-and 50 to 60% reduction after 3-5 years [7,8,11].…”

Administration of a single dose of recombinant human thyrotrophin enhances the efficacy of radioiodine treatment of large compressive multinodular goitres

“…Moreover, in elderly people it is very commonly observed that the long-standing goitre descends into the upper mediastinum space causing compression of the trachea and other cervical structures. Enlarged multinodular toxic and nontoxic goitres can be reduced by radioiodine (RAI), as reported in several studies (Hegedus et al ., 1988;Verelst et al ., 1990;Nygaard et al ., 1993Nygaard et al ., , 1997Huysmans et al ., 1994;Wesche et al ., 1995Wesche et al ., , 2001Howarth et al ., 1997;Kay et al ., 1998;Bonnema et al ., 1999). Surgical treatment, however, may be contraindicated in elderly patients because of cardiac, pulmonary or other disabling disorders (Hermus & Huysmans, 1998;Samuels, 2001;Hegedus et al ., 2003).…”

THERAPY OF ENDOCRINE DISEASE: Recombinant human TSH and radioactive iodine therapy in the management of benign multinodular goiter

“…Overall, LT 4 suppressive therapy offers no benefit (4), particularly regarding the improvement in obstructive symptoms (such as dyspnea and dysphagia), to most patients (5,6). 131 I treatment reduces the MNG volume by w40% after 1 year and by 50-60% after 2-5 years (4,5,6,7,8,9). Nonetheless, the therapeutic efficacy of 131 I in patients with MNG depends to some extent on the 131 I uptake (RAIU).…”