Endocrine Abstracts

Background: Several treatment options exist after thyroid malignancy has been ruled out in patients with multinodular goiter (MG). Surgery efficiently reduces the goiter size but carries a risk of both surgical and anesthetic complications while in recent years, levothyroxine suppressive therapy has been abounded. I131 therapy is the only nonsurgical alternative; however, the effectiveness diminishes with increasing goiter size and depends on iodine sufficiency in some areas. Recombinant human (rh) TSH approximately doubles the thyroid 131I uptake in patients with nodular goiter. Several studies have proved efficacy of rhTSH stimulated 131I therapy on goiter reduction.

Objective: The objective of the study was to assess the efficacy and safety of 0.1 mg rhTSH as an adjuvant to a fix dose of 131I therapy (11 mci) in patients with recurrence of large multinodular goiter several years after the initial thyrodectomy.

Patients and Intervention: 14 (13 females), age 59.14 ±15.44 (range 35-78 years) received 11mciu of I131, 24h after the administration of 0.1 mg rhTSH.

Main Outcome Measures: The primary endpoint was the change in thyroid volume (by ultrasound measurements) as well as in the diameter of the predominant nodule during a follow up period of 10 years. Secondary end points were the alterations in thyroid function and potential adverse effects.

Results: significant decrease in the volume of initial thyroid remnant (32.16±16.66 ml ) was observed from the first reevaluation (at 4 months, 23.12±11.59 ml) as well as at the end of the follow up period (10 years, 12.62±8.76ml), P<0.01. There was a positive correlation between the decreased thyroid volume at 4 months with the volume of thyroid remnant at the end of the study (r=0.407, P=0.014). Significant reduction of the dominant nodule was also observed (from 31.71±10.46 mm in the beginning to 26.67±11.05 mm).

Conclusions: further investigation is needed since this approach could be attractive in terms of minimizing the potential risks of reoperation in these patient