title: Prestimulation with recombinant human thyrotropin (rhTSH) improves the long-term outcome of radioiodine therapy for multinodular nontoxic goiter.
abstract: OBJECTIVE
  The objective of the study was to evaluate the long-term outcome of recombinant human TSH (rhTSH)-augmented radioiodine ((131)I) therapy for benign multinodular nontoxic goiter.
  
  
  METHODS
  Between 2002 and 2005, 86 patients with a multinodular nontoxic goiter were treated with (131)I in two randomized, double-blind, placebo-controlled trials. (131)I-therapy was preceded by 0.3 mg rhTSH (n = 42) or placebo (n = 44). In 2009, 80 patients completed a follow-up (FU) visit, including determination of thyroid volume, thyroid function, and patient satisfaction by a visual analog scale.
  
  
  RESULTS
  In both groups, thyroid volume was further reduced from 1 yr to final FU (71 months). The mean goiter volume reductions obtained at 1 yr and final FU [59.2 ± 2.4% (sem) and 69.7 ± 3.1%, respectively] in the rhTSH group were significantly greater than those obtained in the (131)I-alone group (43.2 ± 3.7 and 56.2 ± 3.6%, respectively, P = 0.001 and P = 0.006), corresponding to a gain of 24% at final FU. At last FU the mean reduction in compression visual analog scale score was significantly greater in patients receiving rhTSH (P = 0.049). Additional therapy (thyroid surgery or (131)I) was required more often in the placebo group (nine of 44) compared with the rhTSH group (two of 42) (P = 0.05). The prevalence of hypothyroidism at 1 yr [9 and 43% in the placebo and rhTSH groups, respectively (P < 0.0001)] increased to 16 and 52%, respectively, at final FU (P = 0.001).
  
  
  CONCLUSIONS
  Enhanced goiter volume reduction with rhTSH-augmented (131)I therapy improves the long-term reduction in goiter-related symptoms and reduces the need for additional therapy compared with plain (131)I therapy. Overall patient satisfaction is benefited, despite a higher rate of permanent hypothyroidism.
authors.affiliation: Departments of Endocrinology, Odense University Hospital, DK-5000 Odense, Denmark. soeren.fast@ouh.regionsyddanmark.dk
authors.forename: Søren
authors.initials: S
authors.lastname: Fast
authors.forename: Viveque Egsgaard
authors.initials: VE
authors.lastname: Nielsen
authors.forename: Peter
authors.initials: P
authors.lastname: Grupe
authors.forename: Henrik
authors.initials: H
authors.lastname: Boel-Jørgensen
authors.forename: Lars
authors.initials: L
authors.lastname: Bastholt
authors.forename: Peter Bøgeskov
authors.initials: PB
authors.lastname: Andersen
authors.forename: Steen Joop
authors.initials: SJ
authors.lastname: Bonnema
authors.forename: Laszlo
authors.initials: L
authors.lastname: Hegedüs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004311:Double-Blind Method; D006044:Goiter, Nodular / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy*; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D017060:Patient Satisfaction; D013961:Thyroid Gland / Q000503:physiopathology; D057073:Thyrotropin Alfa / Q000627:therapeutic use*; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D007457:Iodine Radioisotopes; D057073:Thyrotropin Alfa