Radioiodine therapy in non-toxic multinodular goitre. The possibility of effect-amplification with recombinant human TSH (rhTSH)

Bonnema, Steen Joop; Nielsen, Vibeke Lehmann

doi:10.1080/02841860600617084

Cited by 20 publications

(6 citation statements)

References 61 publications

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“…The concept of rhTSH-stimulated 131 I-therapy of multinodular nontoxic goiter has been thoroughly evaluated in clinical trials during the last decade [46,47,52,[57][58][59][60][61][62][63][64][65][66][67][68], listed in Table 3, and the topic has been discussed in previous reviews [54,[69][70][71][72][73]. Four trials were double-blinded and compared pre-stimulation with either rhTSH or placebo [46,47,66,67].…”

Section: I-therapy Amplification By Rhtsh Stimulationmentioning

confidence: 99%

Non-surgical approach to the benign nodular goiter: new opportunities by recombinant human TSH-stimulated 131I-therapy

Bonnema

Fast

2011

Endocrine

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The optimal treatment strategy in a goiter patient depends--among other factors--on goiter size, the degree of cosmetic or compressive symptoms, the age of the patient, the impact on the upper airways, the wish to maintain normal thyroid function, the ability of the thyroid gland to take up (131)I, and the possibility of thyroid malignancy. When treatment is warranted in a patient with benign goiter, the choice usually stands between surgery and (131)I-therapy. Focal destructive treatment, by ethanol sclerotherapy or interstitial laser photocoagulation, may be considered in patients with a solitary benign nodule. If thyroid hyperfunction due to nodular autonomy is the dominant problem, life-long anti-thyroid drug treatment may be relevant in elderly individuals. With the advent of recombinant human TSH (rhTSH) stimulation the goiter reduction following (131)I-therapy is significantly enhanced and this treatment is of particular benefit, as compared with conventional (131)I-therapy, in patients with a low baseline thyroid (131)I uptake and a large goiter. If the rhTSH dose does not exceed 0.1 mg the risk of temporary hyperthyroidism and acute thyroid swelling is low. Since patient satisfaction seemingly is not improved by the greater goiter reduction obtained by rhTSH-stimulated (131)I-therapy, and permanent hypothyroidism is more frequent, it may be more relevant to reduce the administered radioactivity equivalent to the rhTSH-induced increase in the thyroid (131)I uptake. Future large-scale well-controlled studies should explore this strategy, with focus on cost-benefit and quality of life. A major hindrance of widespread and routine use of rhTSH-stimulated (131)I-therapy is its present status as an off-label treatment.

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Section: I-therapy Amplification By Rhtsh Stimulationmentioning

confidence: 99%

Non-surgical approach to the benign nodular goiter: new opportunities by recombinant human TSH-stimulated 131I-therapy

Bonnema

Fast

2011

Endocrine

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“…Presently, PEI is used only for benign thyroid nodules and cystic or mixed cystic-solids with large fluid components [5, 6]. PEI is quite a low-cost, safe, and outpatient method of treatment.…”

Section: Introductionmentioning

confidence: 99%

A Rare Complication following Thyroid Percutaneous Ethanol Injection: Plummer Adenoma

Cesareo

Naciu

Pasqualini

et al. 2017

Case Reports in Endocrinology

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Percutaneous ethanol injection (PEI) is a technique used only for benign thyroid nodules, cystic or mixed cystic-solid with a large fluid component. It is a quite low-cost, safe, and outpatient method of treatment. Rare and severe complications have been described after PEI: jugular vein thrombosis and severe ethanol toxic necrosis of the larynx combined with necrotic dermatitis. Moreover, only four thyrotoxicosis cases due to Graves' disease have been reported. We report a case of 58-year-old female with a voluminous thyroid cystic nodule, occupying almost the entire left thyroid lobe. Our patient had already performed surgical visit and intervention of thyroidectomy had been proposed to her, which she refused. At baseline, our patient has a normal thyroid function with negative autoantibodies. According to the nodular structure, intervention of PEI has been performed with a significant improvement of compressive symptoms and cosmetic disorders. About 30 days after treatment, there was a significant volume reduction, but patient developed an acclaimed symptomatic thyrotoxicosis. After ruling out several causes of hyperthyroidism and according to the thyroid scintigraphy findings, we made the diagnosis of Plummer adenoma. To our knowledge, our patient is the first case of Plummer adenoma following PEI treatment of nontoxic thyroid nodule.

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“…40 Pre-treatment with recombinant human TSH (rhTSH) has been evaluated in recent years as adjuvant to RAI in several studies as a means to enhance the efficacy of RAI uptake in non-toxic thyroid tissue (in one study RAI uptake doubled), 41 allowing the use of lower doses of RAI 42 and enhancing goiter size reduction. 41,[43][44][45][46] Additionally, pre-treatment with rhTSH has been shown to modify the regional distribution of RAI by stimulating RAI uptake in relatively hypofunctioning regions within a goiter. 47 Painful transient thyroiditis and transient mild thyrotoxicosis, 43 usually within the first month after treatment, and increased incidence of subsequent hypothyroidism have been described.…”

Section: Radioiodine Therapymentioning

confidence: 99%

Multinodular Goiter—Diagnostic and Treatment Considerations

Castro

2008

US Endocrinology

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Epidemiology and Clinical ManifestationsThyroid nodules are common in clinical practice and, although the majority are benign, approximately 5% can harbor malignancy. Their prevalence is highly dependent on the method used for detection. With the increased utilization of ultrasound (US) for evaluation of non-thyroid lesions of the neck, the incidental finding of unsuspected thyroid nodules ('incidentalomas') has dramatically increased. The prevalence of thyroid nodules increases with advancing age and is higher in women. However, thyroid nodules are more likely to be malignant in men, patients with a history of head and neck irradiation, children, and young or older adults (<30 or >60 years of age).

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Radioiodine therapy in non-toxic multinodular goitre. The possibility of effect-amplification with recombinant human TSH (rhTSH)

Cited by 20 publications

References 61 publications

Non-surgical approach to the benign nodular goiter: new opportunities by recombinant human TSH-stimulated 131I-therapy

Non-surgical approach to the benign nodular goiter: new opportunities by recombinant human TSH-stimulated 131I-therapy

A Rare Complication following Thyroid Percutaneous Ethanol Injection: Plummer Adenoma

Multinodular Goiter—Diagnostic and Treatment Considerations

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