Document Detail

¹³¹I treatment of toxic nodular goiter under combined thyrostatic-thyromimetic medication is at low risk of late hypothyroidism.
MedLine Citation:
PMID:  20639819     Owner:  NLM     Status:  MEDLINE    
AIM: Treatment of toxic nodular goiter with ¹³¹I is a first-line therapy for hyperthyroidism. To avoid a thyrotoxic storm, ¹³¹I is usually administered after pretreatment with antithyroid drugs, with thyroid-stimulating hormone (TSH) increase and functional recruitment of inhibited normal tissue. Therefore, both autonomous nodule(s) and normal tissue are irradiated. This may be a reason for late hypothyroidism occurring in 15-25% of patients. This study aimed at assessing different pretreatment modalities with combined methymazole and triiodothyronine, achieving euthyroidism with suppressed TSH.
METHODS: After diagnosis of autonomously functioning toxic nodule, patients were subjected to thyrostatic medication. Two months later, TSH was checked; if >0.5 mU/L triiodothyronine treatment was associated. After 2 more months, if the TSH level was suppressed, patients received ¹³¹I-therapy. A total of 149 patients were consecutively enrolled, 41 of whom with uninodular and 108 with multinodular goiter. They were evaluated at diagnosis, pretreatment, 3 and 6 months after therapy and at late follow-up (6.8+/-4.2 years; range: 1-22 years).
RESULTS: Administered activity was calculated according to ¹³¹I uptake and gland weight. Methymazole was discontinued 6 days before treatment and T3 was maintained until administration of ¹³¹I-therapy. Euthyroidism was achieved in 88% of patients. At late follow-up, subclinical hypothyroidism was observed in 10 patients (6.7%) and overt hypothyroidism in 5 patients (3.3%). No pathological consequences or side effects of ¹³¹I-therapy were found during the 6.8+/-4.2 year follow-up period.
CONCLUSION: Treatment of toxic nodular goiter with ¹³¹I-therapy, under combined thyrostatic-thyromimetic treatment is a simple, safe, well-tolerated, and effective procedure.
B Paghera; M B Panarotto; G Maira; G C Magri; F Bertagna; G Bosio; P Rossini; A De Agostini; G Savelli; S Lucchini; R Giubbini
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Publication Detail:
Type:  Journal Article     Date:  2009-01-01
Journal Detail:
Title:  The quarterly journal of nuclear medicine and molecular imaging : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of Radiopharmaceutical Chemistry and Biology     Volume:  54     ISSN:  1824-4785     ISO Abbreviation:  Q J Nucl Med Mol Imaging     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-07-19     Completed Date:  2010-12-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101213861     Medline TA:  Q J Nucl Med Mol Imaging     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  341-7     Citation Subset:  IM    
Unit of Nuclear Medicine, Civilian Hospitals of Brescia, Brescia, Italy.
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MeSH Terms
Aged, 80 and over
Antithyroid Agents / therapeutic use
Combined Modality Therapy
Goiter, Nodular / drug therapy*,  radiotherapy*
Hypothyroidism / prevention & control
Iodine Radioisotopes / therapeutic use
Methimazole / therapeutic use
Middle Aged
Thyrotoxicosis / drug therapy*,  radiotherapy*
Time Factors
Triiodothyronine / therapeutic use
Reg. No./Substance:
0/Antithyroid Agents; 0/Iodine Radioisotopes; 60-56-0/Methimazole; 6893-02-3/Triiodothyronine

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