Recombinant human thyrotropin-stimulated radioiodine therapy of large nodular goiters facilitates tracheal decompression and improves inspiration.

Abstract

INTRODUCTION:

The impact on tracheal anatomy and respiratory function of recombinant human (rh)TSH-stimulated (131)I therapy in patients with goiter is not clarified.

METHODS:

In a double-blinded design, patients (age 37-87 yr) with a large multinodular goiter (range, 99-440 ml) were randomized to placebo (n = 15) or 0.3 mg rhTSH (n = 14) 24 h before (131)I therapy. The smallest cross-sectional area of the trachea (SCAT; assessed by magnetic resonance imaging) and the pulmonary function were determined before, 1 wk, and 12 months after therapy.

RESULTS:

Data on goiter reduction have been reported previously. In the placebo group, no significant changes in the lung function or SCAT were found throughout the study. In the rhTSH group, a slight decrease was observed in the forced vital capacity 1 wk after therapy, whereas the mean individual change in SCAT was significantly increased by 10.5% (95% confidence interval = 0.9-20.0%). A further increase in SCAT to 117 +/- 36 mm(2) (P = 0.005 compared with 92 +/- 38 mm(2) at baseline) was seen at 12 months, corresponding to a mean of 31.4% (95% confidence interval = 16.0-46.8%). The expiratory parameters did not change significantly, whereas forced inspiratory flow at 50% of the vital capacity (FIF50%) increased from initially 3.34 +/- 1.33 liters/sec to ultimately 4.23 +/- 1.88 liters/sec (P = 0.015) in the rhTSH group, corresponding to a median increase of 24.6%. By 12 months, the relative improvements in FIF50% and in SCAT were inversely correlated to the respective baseline values (FIF50%: r = -0.47, P = 0.012; SCAT: r = -0.57, P = 0.001).

CONCLUSION:

On average, neither compression of the trachea nor deterioration of the pulmonary function was observed in the acute phase after rhTSH-augmented (131)I therapy. In the long term, tracheal compression is diminished, and the inspiratory capacity improved, compared with (131)I therapy alone.

• Authors: Steen J Bonnema, Viveque E Nielsen, Henrik Boel-Jørgensen, Peter Grupe, Peter B Andersen, Lars Bastholt, Laszlo Hegedüs
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 93 Issue 10 Pg. 3981-4 (Oct 2008) ISSN: 0021-972X [Print] United States
• PMID: 18664541 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Iodine Radioisotopes
• Placebos
• Recombinant Proteins
• Thyrotropin

Topics

• Adult
• Aged
• Aged, 80 and over
• Airway Obstruction (drug therapy, etiology, physiopathology, radiotherapy)
• Chemotherapy, Adjuvant
• Double-Blind Method
• Female
• Goiter, Nodular (complications, drug therapy, pathology, radiotherapy)
• Humans
• Inhalation (drug effects, radiation effects)
• Inspiratory Capacity (drug effects, radiation effects)
• Iodine Radioisotopes (therapeutic use)
• Male
• Middle Aged
• Organ Size (drug effects, radiation effects)
• Placebos
• Recombinant Proteins (therapeutic use)
• Thyrotropin (therapeutic use)
• Trachea (pathology, physiopathology)
• Tracheal Diseases (drug therapy, etiology, physiopathology, radiotherapy)
• Treatment Outcome