A 30-year perspective on radioiodine therapy of benign nontoxic multinodular goiter.

Abstract

PURPOSE OF REVIEW:

There is no consensus on the ideal treatment of patients with a benign nontoxic multinodular goiter. In some European countries, (131)I therapy has replaced surgery as the treatment of choice in these patients. Recombinant human thyrotropin (rhTSH) is a very potent stimulator of the thyroid gland and this review focuses on rhTSH-stimulated (131)I therapy.

RECENT FINDINGS:

The concept of rhTSH-stimulated (131)I therapy has been tested in several trials during the last 8 years. With this treatment, the goiter reduction is improved by 35-55%, compared with (131)I therapy without rhTSH stimulation. RhTSH prestimulation is particularly beneficial in patients with very large goiters and in those with a low baseline thyroid (131)I uptake. In addition, this therapy facilitates tracheal decompression leading to improved respiratory function. RhTSH-stimulated (131)I therapy results in a higher rate of permanent hypothyroidism, whereas other side-effects are very modest when using a rhTSH dose of 0.1 mg or below.

SUMMARY:

RhTSH-stimulated radioiodine therapy of benign nontoxic multinodular goiter is still an off-label use but several trials have shown that this treatment is significantly more effective than (131)I therapy without rhTSH. However, no trial has yet compared (131)I therapy and surgery head-to-head, and future trials should include evaluation of quality of life and cost.

• Authors: Steen J Bonnema, Laszlo Hegedüs
• Journal: Current opinion in endocrinology, diabetes, and obesity (Curr Opin Endocrinol Diabetes Obes) Vol. 16 Issue 5 Pg. 379-84 (Oct 2009) ISSN: 1752-2978 [Electronic] England
• PMID: 19623060 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Iodine Radioisotopes
• Radiation-Sensitizing Agents
• Recombinant Proteins
• Thyrotropin

Topics

• Combined Modality Therapy (methods)
• Goiter, Nodular (pathology, radiotherapy, surgery)
• Humans
• Iodine Radioisotopes (adverse effects, therapeutic use)
• Radiation-Sensitizing Agents (therapeutic use)
• Recombinant Proteins (therapeutic use)
• Thyrotropin (therapeutic use)