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  • Title: A 30-year perspective on radioiodine therapy of benign nontoxic multinodular goiter.
    Author: Bonnema SJ, Hegedüs L.
    Journal: Curr Opin Endocrinol Diabetes Obes; 2009 Oct; 16(5):379-84. PubMed ID: 19623060.
    Abstract:
    PURPOSE OF REVIEW: There is no consensus on the ideal treatment of patients with a benign nontoxic multinodular goiter. In some European countries, (131)I therapy has replaced surgery as the treatment of choice in these patients. Recombinant human thyrotropin (rhTSH) is a very potent stimulator of the thyroid gland and this review focuses on rhTSH-stimulated (131)I therapy. RECENT FINDINGS: The concept of rhTSH-stimulated (131)I therapy has been tested in several trials during the last 8 years. With this treatment, the goiter reduction is improved by 35-55%, compared with (131)I therapy without rhTSH stimulation. RhTSH prestimulation is particularly beneficial in patients with very large goiters and in those with a low baseline thyroid (131)I uptake. In addition, this therapy facilitates tracheal decompression leading to improved respiratory function. RhTSH-stimulated (131)I therapy results in a higher rate of permanent hypothyroidism, whereas other side-effects are very modest when using a rhTSH dose of 0.1 mg or below. SUMMARY: RhTSH-stimulated radioiodine therapy of benign nontoxic multinodular goiter is still an off-label use but several trials have shown that this treatment is significantly more effective than (131)I therapy without rhTSH. However, no trial has yet compared (131)I therapy and surgery head-to-head, and future trials should include evaluation of quality of life and cost.
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