Therapy of large multinodular goitre using repeated doses of radioiodine.
OBJECTIVE
To evaluate the efficacy of radioiodine therapy using I in a group of patients with large multinodular goitre (LMG).


METHODS
The study was carried out in patients with goitre volume greater than 100 cm and in patients with LMG who were disqualified from surgery. The study included 34 female participants (age range: 62-84 years) with LMG: 26 patients were hyperthyroid and eight patients had a nontoxic goitre. The patients were treated with 800 MBq of radioiodine administered four times at 3-month intervals (total activity of 3.2 GBq). Before each therapy course, serum thyrotropin, free thyroxin, free triiodothyronine and antithyroid antibodies were measured, ultrasonography and thyroid scan were performed. Patients were followed up for a minimum of 24 months. Fine-needle biopsy was done before qualification to the study.


RESULTS
Before therapy, median thyroid volume was 145 cm. It decreased during therapy to 65-76 cm after 12 months and to 50-62 cm after 24 months. After 24 months, 60% of patients were euthyroid and 40% of patients were hypothyroid. During therapy, significant increases in TSHRAb, TPOAb and TgAb levels were observed. No correlation between the levels of antithyroid antibodies, radioiodine uptake, reduction of goitre volume and hormonal status was found.


CONCLUSIONS
In most cases of LMG, repeated administration of radioiodine is safe and effective. The highest response of the thyroid volume is observed after the first course of treatment. On account of a high incidence of hypothyroidism, the patients should be monitored during and after therapy.
Baczyk
Maciej
M
Department of Endocrinology, Metabolism and Internal Diseases, Poznań University of Medical Sciences, Poland.
Pisarek
Marlena
M
Czepczyński
Rafał
R
Ziemnicka
Katarzyna
K
Gryczyńska
Maria
M
Pietz
Leszek
L
Sowiński
Jerzy
J
D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006042:Goiter / Q000276:immunology / Q000473:pathology / Q000532:radiotherapy* / Q000628:therapy; D006801:Humans; D007457:Iodine Radioisotopes / Q000378:metabolism / Q000627:therapeutic use; D008875:Middle Aged; D011829:Radiation Dosage; D011879:Radiotherapy Dosage; D011795:Surveys and Questionnaires; D013961:Thyroid Gland / Q000276:immunology; D016896:Treatment Outcome
D000906:Antibodies; D007457:Iodine Radioisotopes