title: Cardiovascular assessment of hyperthyroid patients with multinodular goiter before and after radioiodine treatment preceded by stimulation with recombinant human TSH.
abstract: Treatment of large multinodular goiter (MNG) with radioiodine preceded by recombinant human thyrotropin (0.1 mg rhTSH) has been shown to be a safe alternative for patients with comorbidities that preclude surgery. However, the increase in serum thyroid hormones that follows both treatments may be harmful for some patients, particularly those with underlying cardiovascular disease. In this study, we evaluated cardiac parameters (clinical, ECG, 24-h Holter, Doppler echocardiogram, treadmill stress test) in 27 of 42 patients (ages 42-80 years) with large MNGs who were treated with rhTSH before receiving 30 mCi radioiodine therapy. At baseline, 18 patients had subclinical and six patients had overt iodine-induced hyperthyroidism. All patients had a transient surge in serum levels of free T4 and total T3 into the hyperthyroid range after therapy. However, repeated cardiac evaluation did not show significant changes as compared with baseline evaluation. In conclusion, rhTSH stimulated RAI treatment of MNG did not affect structural and functional parameters of the heart, despite transient high-serum levels of thyroid hormones.
authors.affiliation: Thyroid Unit, Division of Endocrinology, Department of Medicine, University of Sao Paulo Medical School, Sao Paulo, 01246-000, Brazil.
authors.forename: Maria Fernanda
authors.initials: MF
authors.lastname: Barca
authors.forename: Cesar
authors.initials: C
authors.lastname: Gruppi
authors.forename: Mucio T
authors.initials: MT
authors.lastname: Oliveira
authors.forename: Rossana
authors.initials: R
authors.lastname: Romão
authors.forename: Maria Silvia
authors.initials: MS
authors.lastname: Cárdia
authors.forename: Ileana
authors.initials: I
authors.lastname: Rubio
authors.forename: Meyer
authors.initials: M
authors.lastname: Knobel
authors.forename: Geraldo
authors.initials: G
authors.lastname: Medeiros-Neto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002319:Cardiovascular System / Q000187:drug effects / Q000503:physiopathology* / Q000528:radiation effects; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006044:Goiter, Nodular / Q000150:complications / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D006980:Hyperthyroidism / Q000188:drug therapy* / Q000209:etiology / Q000532:radiotherapy*; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use; D013963:Thyroid Hormones / Q000097:blood; D013972:Thyrotropin / Q000627:therapeutic use*
chemical_list: D007457:Iodine Radioisotopes; D011994:Recombinant Proteins; D013963:Thyroid Hormones; D013972:Thyrotropin