Diagnosis and management of large toxic multinodular goiters.
Toxic multinodular goiters, estimated weight 100 g or more, occurred in 35 patients between 1961 and 1984. All but two were older than 50; 32 were females. Twenty had goiters of 100-130 g; four of 140-200 g; and 11 were massive. Radioiodine uptakes were 30% or less for 22. Seven of 17 with both T4 and T3 data had T4 toxicosis. Thirty-two patients received radioiodine therapy, delivering 200 microCi per gram when possible. Doses were 25-30 mCi for 17 patients; 50-100 mCi for 12 patients, and 150-200 mCi for three patients. Hyperthyroidism was eliminated with one dose in 25 patients (78%); five patients required two doses. Twenty-two patients were euthyroid after radioiodine; 25 of 28 had persistent goiters. Two patients were treated successfully surgically. One refused surgery and radioiodine, and has been maintained on antithyroid drugs for 10 yr. Two patients died within a few months of an unsuccessful initial dose of radioiodine. Large dose radioiodine therapy is simple, safe, and effective for most patients with large toxic multinodular goiters.
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D000328:Adult; D000368:Aged; D013956:Antithyroid Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D006044:Goiter, Nodular / Q000150:complications / Q000175:diagnosis* / Q000532:radiotherapy / Q000628:therapy; D006111:Graves Disease / Q000175:diagnosis; D006331:Heart Diseases / Q000209:etiology / Q000628:therapy; D006801:Humans; D006980:Hyperthyroidism / Q000209:etiology / Q000628:therapy; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D013963:Thyroid Hormones / Q000097:blood; D013965:Thyroidectomy
D013956:Antithyroid Agents; D007457:Iodine Radioisotopes; D013963:Thyroid Hormones