title: Recombinant human thyrotropin stimulation prior to131I therapy in toxic multinodular goitre with low radioactive iodine uptake.
abstract: OBJECTIVE
  Stimulation with recombinant human thyrotropin (rhTSH) increases thyroid radioiodine uptake, and is an aid to131I therapy in non-toxic multinodular goitre (MNG). However, there are not many studies using rhTSH prior to131I in toxic multinodular goitre to improve hyperthyroidism and compressive symptoms.
  
  
  METHODS
  A prospective study was conducted on patients with MNG and hyperthyroidism. Patients were recruited consecutively and divided into group I, stimulated with 0.3mg of rhTSH before radioiodine therapy, and a control group or group II, without stimulation. Thyroid function, radioiodine thyroid uptake, thyroid weight, and compressive symptoms were measured, and patients were followed-up for 9 months.
  
  
  RESULTS
  Group I consisted of 16 patients (14 women), with a mean age 69.7 years, and group II with 16 patients (12 women), with a mean age 70.7 years. After stimulation with 0.3mg rhTSH in group I,131I uptake (RAIU) at 24h increased by 78.4%, and the estimated absorbed dose by 89.3%. In group II, the estimated absorbed dose was lower than group I after stimulation with rhTSH (29.8Gy vs. 56.4Gy; P=0.001). At 9 months of follow-up, hyperthyroidism was controlled in 87.5% of patients in group I, and 56.2% in group II (P=0.049). The mean reduction in thyroid weight was higher in group I than in group II (39.3% vs. 26.9%; P=0.017), with a tendency towards subjective improvement of compressive symptoms in group I, although non-significant. Only 2 patients described tachycardias after rhTSH administration, which were resolved with beta-blockers.
  
  
  CONCLUSIONS
  Stimulation with 0.3mg of recombinant human thyrotropin prior to radioiodine therapy achieves a reduction in thyroid weight and functional improvement in patients with hyperthyroidism and multinodular goitre with low uptake, and with no need for hospital admission.
authors.affiliation: Hospital Universitario de San Juan de Alicante, San Juan de Alicante, España. Electronic address: mariajoazo@gmail.com.
authors.forename: M J
authors.initials: MJ
authors.lastname: Azorín Belda
authors.affiliation: Hospital Universitario de San Juan de Alicante, San Juan de Alicante, España.
authors.forename: A
authors.initials: A
authors.lastname: Martínez Caballero
authors.affiliation: Hospital Universitario de San Juan de Alicante, San Juan de Alicante, España.
authors.forename: G C
authors.initials: GC
authors.lastname: Figueroa Ardila
authors.affiliation: Hospital Universitario de San Juan de Alicante, San Juan de Alicante, España.
authors.forename: M
authors.initials: M
authors.lastname: Martínez Ramírez
authors.affiliation: Hospital Universitario de San Juan de Alicante, San Juan de Alicante, España.
authors.forename: C A
authors.initials: CA
authors.lastname: Gómez Jaramillo
authors.affiliation: Hospital Universitario de San Juan de Alicante, San Juan de Alicante, España.
authors.forename: J I
authors.initials: JI
authors.lastname: Dolado Ardit
authors.affiliation: Hospital Universitario de San Juan de Alicante, San Juan de Alicante, España.
authors.forename: J
authors.initials: J
authors.lastname: Verdú Rico
mesh_terms: D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology; D055154:Dysphonia / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006044:Goiter, Nodular / Q000150:complications / Q000378:metabolism / Q000532:radiotherapy*; D065386:Historically Controlled Study; D006801:Humans; D006980:Hyperthyroidism / Q000209:etiology / Q000532:radiotherapy; D007457:Iodine Radioisotopes / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009929:Organ Size / Q000187:drug effects; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000494:pharmacology; D013961:Thyroid Gland / Q000187:drug effects* / Q000378:metabolism; D013972:Thyrotropin / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D007457:Iodine Radioisotopes; C000614965:Iodine-131; D011994:Recombinant Proteins; D013972:Thyrotropin
keywords: Bocio multinodular; Bocio multinodular tóxico; Hipertiroidismo; Hyperthyroidism; Multinodular goitre; Radioiodine; Radioyodo; Toxic multinodular goitre; rhTSH