An outline concerning the potential use of recombinant human thyrotropin for improving radioiodine therapy of multinodular goiter.
Radioiodine ((131)I) treatment for nontoxic and toxic multinodular goiter (MNG) is an alternative therapeutic procedure used especially for patients with contraindication for surgery. Several studies have been conducted in recent years assessing the use of recombinant human TSH (rhTSH) in increasing (131)I uptake in MNGs. This procedure also decreases the activity level of the administered (131)I, changes the distribution of (131)I in the thyroid, lowers the absorption dose, and dramatically reduces the volume of the goiter (50-75% of the baseline volume). A major disadvantage, however, is the induction of hypothyroidism in a relatively large number of patients. A transient increase in thyroid volume and tenderness was noted in the first week of treatment. Also a short period (2-4 weeks) of hyperthyroidism was observed in most patients with potential consequences particularly for the elderly. Still, there has been no evidence to date that the adverse effects outweigh the positive results of using rhTSH. The use of rhTSH in benign goiter disease has not yet been approved worldwide, but its positive activity in MNG is remarkable and promising.
Medeiros-Neto
Geraldo
G
Thyroid Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of Sao Paulo Medical School, Av Dr. Eneas de Carvalho Aguiar, 155, PAmb 8 A, bl 3, Sao Paulo, SP, 05403-900, Brazil.
Marui
Suemi
S
Knobel
Meyer
M
D001323:Autoantibodies / Q000032:analysis / Q000276:immunology; D006044:Goiter, Nodular / Q000150:complications / Q000276:immunology / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D013972:Thyrotropin / Q000009:adverse effects / Q000627:therapeutic use*
D001323:Autoantibodies; D007457:Iodine Radioisotopes; D011994:Recombinant Proteins; D013972:Thyrotropin