Objective: To evaluate the effectiveness of radioiodine therapy as an alternative for surgery in elderly patients with a large, compressive goiter using objective methods for measuring thyroid volume and tracheal compression.
Design: Prospective study.
Setting: University hospital in the Netherlands.
Patients: 19 patients (mean age ±SD, 66 ±14 years) with a large, compressive multinodular goiter who had a high operative risk or refused to have thyroid surgery.
Intervention: A single intravenous dose of Iodine-131 at 2.6 ±1.0 GBq (70 ±28 mCi) (3.7 MBq or 100 microcuries/g of thyroid tissue), followed by daily administration of L-thyroxine in doses that did not suppress thyroid-stimulating hormone.
Measurements: Clinical evaluation and measurements of thyroid volume, maximal tracheal deviation, and the smallest cross-sectional area of the tracheal lumen with magnetic resonance imaging before and 1 year after Iodine-131 treatment.
Results: No exacerbation of compressive symptoms after Iodine-131 therapy was observed. Thyroid volume was 269 ±153 mL before treatment and 154 ±73 mL 1 year after treatment (P < 0.001). Thyroid volume was reduced 40% ±15% (range, 19% to 68%). Maximal tracheal deviation (1.9 ±0.8 cm before and 1.5 ±0.7 cm 1 year after therapy) had decreased by 20% ±20% (range, −4% to 73%; P < 0.001), and the smallest cross-sectional area of the tracheal lumen (0.78 ±0.38 cm2 before and 1.04 ±0.48 cm2 1 year after therapy) had increased by 36% ±38% (range, −3% to 125%; P < 0.001). Clinical signs and symptoms improved in 8 of 12 patients with dyspnea and inspiratory stridor and in both patients with compression of the superior vena cava.
Conclusions: Therapy with Iodine-131 is an effective alternative to surgery for elderly patients with a large, compressive multinodular goiter.