A randomized trial comparing levothyroxine with radioactive iodine in the treatment of sporadic nontoxic goiter.
A randomized clinical trial was performed in consecutive patients with sporadic nontoxic nodular goiter to compare efficacy and side effects of iodine-131 ((131)I) therapy with suppressive levothyroxine (L-thyroxine) treatment. Sixty-four patients were randomized after stratification for sex and menopausal age to receive (131)I (4.44 MBq/g thyroid; group A) or suppressive L-thyroxine treatment aiming at TSH values between 0.01 and 0.1 mU/L (group B). The main outcome measurements after 2 yr were goiter size by ultrasound, serum thyroid function tests, markers of bone turnover, and bone mineral density (BMD). Fifty-seven patients completed the trial. Goiter size was reduced after 2 yr by 44% in group A and by 1% in group B (P< 0.001). Nonresponders (goiter reduction <13%) were 1 of 29 patients in group A and 16 of 28 patients in group B (P = 0.00001). In responders, goiter reduction in group A (46%) was greater than in group B (22%; P< 0.005). In group A, 45% of patients developed hypothyroidism. In group B, 10 patients experienced thyrotoxic symptoms, requiring discontinuation of treatment in 2 (in 1 because of atrial fibrillation). Markers of bone formation and bone resorption increased significantly in group B, related to a mean decrease of 3.6% of BMD at the lumbar spine after 2 yr (from 1.09 +/- 0.22 to 1.05 +/- 0.23 g/cm(2); P< 0.001), both in pre- and postmenopausal women. No changes in BMD were observed in group A. In conclusion, (131)I therapy is more effective and better tolerated than L-thyroxine treatment in patients with sporadic nontoxic goiter. Suppressive L-thyroxine treatment results in significant bone loss.
Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
M F
MF
Wesche
M M
MM
Tiel-V Buul
P
P
Lips
N J
NJ
Smits
W M
WM
Wiersinga
D015519:Bone Density; D016723:Bone Remodeling; D005260:Female; D006042:Goiter / Q000097:blood / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007037:Hypothyroidism / Q000209:etiology; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008593:Menopause; D008875:Middle Aged; D017698:Postmenopause; D013971:Thyrotoxicosis / Q000139:chemically induced; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D014463:Ultrasonography
D007457:Iodine Radioisotopes; D013972:Thyrotropin; D013974:Thyroxine