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.

PATIENTS AND 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).

CONCLUSION:

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: Søren Fast, Viveque Egsgaard Nielsen, Peter Grupe, Henrik Boel-Jørgensen, Lars Bastholt, Peter Bøgeskov Andersen, Steen Joop Bonnema, Laszlo Hegedüs
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 97 Issue 8 Pg. 2653-60 (Aug 2012) ISSN: 1945-7197 [Electronic] United States
• PMID: 22577172 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Iodine Radioisotopes
• Thyrotropin Alfa

Topics

• Aged
• Aged, 80 and over
• Double-Blind Method
• Goiter, Nodular (pathology, physiopathology, radiotherapy)
• Humans
• Iodine Radioisotopes (therapeutic use)
• Patient Satisfaction
• Thyroid Gland (physiopathology)
• Thyrotropin Alfa (therapeutic use)
• Time Factors
• Treatment Failure