A 30-year perspective on radioiodine therapy of benign nontoxic multinodular goiter.
OBJECTIVE
There is no consensus on the ideal treatment of patients with a benign nontoxic multinodular goiter. In some European countries, (131)I therapy has replaced surgery as the treatment of choice in these patients. Recombinant human thyrotropin (rhTSH) is a very potent stimulator of the thyroid gland and this review focuses on rhTSH-stimulated (131)I therapy.


RESULTS
The concept of rhTSH-stimulated (131)I therapy has been tested in several trials during the last 8 years. With this treatment, the goiter reduction is improved by 35-55%, compared with (131)I therapy without rhTSH stimulation. RhTSH prestimulation is particularly beneficial in patients with very large goiters and in those with a low baseline thyroid (131)I uptake. In addition, this therapy facilitates tracheal decompression leading to improved respiratory function. RhTSH-stimulated (131)I therapy results in a higher rate of permanent hypothyroidism, whereas other side-effects are very modest when using a rhTSH dose of 0.1 mg or below.


CONCLUSIONS
RhTSH-stimulated radioiodine therapy of benign nontoxic multinodular goiter is still an off-label use but several trials have shown that this treatment is significantly more effective than (131)I therapy without rhTSH. However, no trial has yet compared (131)I therapy and surgery head-to-head, and future trials should include evaluation of quality of life and cost.
Bonnema
Steen J
SJ
Department of Endocrinology and Metabolism, Odense University Hospital, Odense C, Denmark. steen.bonnema@dadlnet.dk
Hegedüs
Laszlo
L
D003131:Combined Modality Therapy / Q000379:methods; D006044:Goiter, Nodular / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D013972:Thyrotropin / Q000627:therapeutic use
D007457:Iodine Radioisotopes; D011838:Radiation-Sensitizing Agents; D011994:Recombinant Proteins; D013972:Thyrotropin