title: Radioiodine plus recombinant human thyrotropin do not cause acute airway compression and are effective in reducing multinodular goiter.
abstract: Recombinant human thyrotropin (rhTSH) reduces the activity of radioiodine required to treat multinodular goiter (MNG), but acute airway compression can be a life-threatening complication. In this prospective, randomized, double-blind, placebo-controlled study, we assessed the efficacy and safety (including airway compression) of different doses of rhTSH associated with a fixed activity of 131I for treating MNG. Euthyroid patients with MNG (69.3 +/- 62.0 mL, 20 females, 2 males, 64 +/- 7 years) received 0.1 mg (group I, N = 8) or 0.01 mg (group II, N = 6) rhTSH or placebo (group III, N = 8), 24 h before 1.11 GBq 131I. Radioactive iodine uptake was determined at baseline and 24 h after rhTSH and thyroid volume (TV, baseline and 6 and 12 months after treatment) and tracheal cross-sectional area (TCA, baseline and 2, 7, 180, and 360 days after rhTSH) were determined by magnetic resonance; antithyroid antibodies and thyroid hormones were determined at frequent intervals. After 6 months, TV decreased significantly in groups I (28.5 +/- 17.6%) and II (21.6 +/- 17.8%), but not in group III (2.7 +/- 15.3%). After 12 months, TV decreased significantly in groups I (36.7 +/- 18.1%) and II (37.4 +/- 27.1%), but not in group III (19.0 +/- 24.3%). No significant changes in TCA were observed. T3 and free T4 increased transiently during the first month. After 12 months, 7 patients were hypothyroid (N = 3 in group I and N = 2 in groups II and III). rhTSH plus a 1.11-GBq fixed 131I activity did not cause acute or chronic changes in TCA. After 6 and 12 months, TV reduction was more pronounced among patients treated with rhTSH plus 131I.
authors.affiliation: Instituto de Diabetes e Endocrinologia de Maringá, PR, Brasil. ccalbino@uol.com.br
authors.forename: C C
authors.initials: CC
authors.lastname: Albino
authors.forename: H
authors.initials: H
authors.lastname: Graf
authors.forename: G
authors.initials: G
authors.lastname: Paz-Filho
authors.forename: L A
authors.initials: LA
authors.lastname: Diehl
authors.forename: M
authors.initials: M
authors.lastname: Olandoski
authors.forename: A
authors.initials: A
authors.lastname: Sabbag
authors.forename: C
authors.initials: C
authors.lastname: Buchpiguel
mesh_terms: D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000209:etiology; D001323:Autoantibodies / Q000097:blood; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D005260:Female; D006044:Goiter, Nodular / Q000628:therapy*; D006801:Humans; D007457:Iodine Radioisotopes / Q000008:administration & dosage* / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage; D013960:Thyroid Function Tests; D013972:Thyrotropin / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D001323:Autoantibodies; D007457:Iodine Radioisotopes; D011994:Recombinant Proteins; D013972:Thyrotropin