Low-dose recombinant human thyrotropin-aided radioiodine treatment of large, multinodular goiters in elderly patients.
OBJECTIVE
We aimed to assess low-dose recombinant human thyroid-stimulating hormone (rhTSH)-aided, fixed-activity radioiodine therapy of large, multinodular goiters (MNGs) in elderly patients with comorbidities.


METHODS
This was a short-term, observational study.


METHODS
We measured 24-h thyroid radioiodine uptake (RAIU) of 2 microCi 131-iodine at baseline and 24 h after intramuscular injection of 0.03 mg rhTSH in 17 patients (aged 60-86 years, 12 women), who subsequently received 30 mCi 131-iodine 24 h after an identical rhTSH injection. TSH and free thyroxine (FT4) were measured at baseline and days 10, 30 and 90 after therapy. Thyroid volume was assessed by computed tomography at baseline and day 180.


RESULTS
rhTSH, 0.03 mg, significantly increased mean 24-h thyroid RAIU from 25.8% +/- 10.3% to 43.3% +/- 8.4% (68% relative increase; t(16) = -8.43, P < 0.001). The proportion of patients overtly or subclinically hyperthyroid (TSH < 0.5 mU/l) decreased from 71% (12/17) at baseline to 19% (3/16) at 3 months. Mean serum FT4 peaked at slightly above normal range, 25.9 +/- 7.7 pmol/l (46% over baseline) and was 21% under baseline levels at 3 months. Mean estimated thyroid volume fell 34% from baseline to 6 months (170.0 +/- 112.8 to 113.1 +/- 97.5 ml; P < 0.01). Symptomatic relief, improved well-being, and/or reduction or elimination of antihyperthyroid medication were seen in 76% of patients. Three (18%) patients had transient neck pain or tenderness, or palpitations; one had transient asymptomatic thyroid enlargement; and three (18%) became hypothyroid by 3 months.


CONCLUSIONS
Intramuscular rhTSH, 0.03 mg, followed 24 h later by 30 mCi 131-iodine, is a safe, effective and convenient treatment for MNG in elderly patients with comorbidities.
Cohen
Ohad
O
Institute of Endocrinology, Chaim Sheba Medical Center, Tel Hashomer, Israel. ohdcohen@sheba.health.gov.il
Ilany
Jacob
J
Hoffman
Chen
C
Olchovsky
David
D
Dabhi
Sari
S
Karasik
Avraham
A
Goshen
Elinor
E
Rotenberg
Galina
G
Zwas
S Tzila
ST
D000368:Aged; D000369:Aged, 80 and over; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006044:Goiter, Nodular / Q000097:blood / Q000532:radiotherapy*; D006801:Humans; D007457:Iodine Radioisotopes / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000008:administration & dosage; D013972:Thyrotropin / Q000008:administration & dosage* / Q000097:blood; D013974:Thyroxine / Q000097:blood; D014057:Tomography, X-Ray Computed; D014284:Triiodothyronine / Q000097:blood
D007457:Iodine Radioisotopes; D011994:Recombinant Proteins; D014284:Triiodothyronine; D013972:Thyrotropin; D013974:Thyroxine