title: Effect of 30 mCi radioiodine on multinodular goiter previously treated with recombinant human thyroid-stimulating hormone.
abstract: Recombinant human thyroid-stimulating hormone (rhTSH) enhances 131I uptake, permitting a decrease in radiation for the treatment of multinodular goiter (MNG). Our objective was to evaluate the safety and efficacy of a single 0.1-mg dose of rhTSH, followed by 30 mCi 131I, in patients with MNG. Seventeen patients (15 females, 59.0 +/- 13.1 years), who had never been submitted to 131I therapy, received a single 0.1-mg injection of rhTSH followed by 30 mCi 131I on the next day. Mean basal thyroid volume measured by computed tomography was 106.1 +/- 64.4 mL. 131I 24-h uptake, TSH, free-T4, T3, thyroglobulin, anti-thyroid antibodies, and thyroid volume were evaluated at regular intervals of 12 months. Mean 131I 24-h uptake increased from 18.1 +/- 9.7 to 49.6 +/- 13.4% (P < 0.001), a median 2.6-fold increase (1.2 to 9.2). Peak hormonal levels were 10.86 +/- 5.44 mU/L for TSH (a median 15.5-fold increase), 1.80 +/- 0.48 ng/dL for free-T4, 204.61 +/- 58.37 ng/dL for T3, and a median of 557.0 ng/mL for thyroglobulin. The adverse effects observed were hyperthyroidism (17.6%), painful thyroiditis (29.4%) and hypothyroidism (52.9%). Thyroid volume was reduced by 34.3 +/- 14.3% after 6 months (P < 0.001) and by 46.0 +/- 14.6% after 1 year (P < 0.001). Treatment of MNG with a single 0.1-mg dose of rhTSH, followed by a fixed amount of radioactivity of 131I, leads to an efficacious decrease in thyroid volume for the majority of the patients, with a moderate incidence of non-serious and readily treatable adverse effects.
authors.affiliation: Serviço de Endocrinologia e Metabologia, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brasil. gpazfilho@med.miami.edu
authors.forename: G J
authors.initials: GJ
authors.lastname: Paz-Filho
authors.forename: C O
authors.initials: CO
authors.lastname: Mesa-Junior
authors.forename: M
authors.initials: M
authors.lastname: Olandoski
authors.forename: L C
authors.initials: LC
authors.lastname: Woellner
authors.forename: C A
authors.initials: CA
authors.lastname: Goedert
authors.forename: C L
authors.initials: CL
authors.lastname: Boguszewski
authors.forename: G A
authors.initials: GA
authors.lastname: Carvalho
authors.forename: H
authors.initials: H
authors.lastname: Graf
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006044:Goiter, Nodular / Q000188:drug therapy / 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*; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes; D011994:Recombinant Proteins; D013972:Thyrotropin