1.Successful reduction in thyroid and nodule volumes in large solitary and multinodular goiters with serial 131 iodine therapy
April Melody T. Abcede ; Sjoberg A. Kho ; Bien J. Matawaran ; Leilani B. Mercado-Asis
Philippine Journal of Internal Medicine 2017;55(4):1-5
Introduction:
131Iodine therapy is effective in nodular nontoxic goiter with enhanced effects using recombinant
thyroid stimulating hormone (rTSH). The eventual fibrosis
of the thyroid tissue and blood vessels ligates the vascular
supply of the nodule. The study aims to show the successful
reduction of thyroid and nodule volumes in large solitary and
multinodular goiters using serial low dose 131iodine therapy
(10mCi) at three to six months interval.
Methods:
A retrospective analytical study was done from
January 2010 to December 2012 and included twenty three
patients with enlarged solitary and multinodular (nodule/s
≥2cm) non-toxic goiter (females: age range 35-65yrs) given
serial 131iodine therapy (eight to10mCi) at three to six-month
interval. Before each course, serum thyroid stimulating
hormone (TSH) was done to document hypothyroidism
while thyroid gland and nodule sizes were monitored by
ultrasonographic measurements serially with each 131iodine
therapy. Relief of compressive symptoms was monitored on
follow-up at clinic.
Results:
Thyroid size reduced by 38-40% from baseline after
first radioactive iodine (RAI) and by 33-39% after the second RAI. Thyroid nodules reduced by 63-69% and 11-25% serially.
Significant reduction was noted after the first RAI. One
subject underwent third RAI with 80-85% overall reduction in
nodule size. All patients developed post-RAI hypothyroidism
and overall had greater than 50% increase in levothyroxine
replacement dose after the last RAI. Significant relief of
compressive symptoms was noted by 91% post-therapy.
Four thyroid nodules disappeared which resulted in reduced
total number of thyroid nodules from 29 to 25 nodules post
serial RAI.
Conclusion
Serial 131iodine therapy proved to have
thyroid and nodule size reduction by more than 70% in
this study. Among patients who do not consent or have
contraindications to surgery, serial 131iodine therapy may be
considered a safe and effective non-surgical alternative.
Goiter