Radioiodine therapy in voluminous multinodular non-toxic goitre

Abstract

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...

Wole guzowate olbrzymie — ambulatoryjne leczenie radiojodem

“…The authors of the studies with a longer follow-up report as much as a 71.9 % reduction [21]. Verelst et al observed the best results after less than a year of treatment with a nearly maximum effect 24 to 30 months after the therapy [23]. Similarly to what Nygaard et al reported in toxic goitre, we observed the greatest decrease in goitre volume within the first 3 months after the treatment, with a subsequent decrease in reduction degree [2].…”

Controversies in radioiodine therapy: relation to ophthalmopathy, the possible radioprotective effect of antithyroid drugs, and use in large goitres

“…Huysmans et al (78) reported that 67% of the patients improved or were cured of dyspnoea or stridor, and even more were relieved of dysphagia. In other studies (69,76,77), the vast majority of patients reported satisfaction with the outcome of therapy.…”

Single, very low dose (0.03 mg) of recombinant human thyrotropin (rhTSH) effectively increases radioiodine uptake in the I-131 treatment of large nontoxic multinodular goiter

“…Despite the fact that RIT has been used in the treatment of thyroid diseases for over 70 years, some authors still consider it to be an unreliable method producing no satisfying results in the case of non-toxic nodular goiter [5,6,19,20]. First reports on Original non-invasive attempts at reducing goiter volume with I-131 were published at the beginning of the 1990s [21,22].…”