The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

Large, Compressive Goiters Treated with Radioiodine

Dyde A.K.C. Huysmans, MD; Ad R.M.M. Hermus, MD; Frans H.M. Corstens, MD; Jelle O. Barentsz, MD; and Peter W.C. Kloppenborg, MD
[+] Article, Author, and Disclosure Information

From the University Hospital Nijmegen, Nijmegen, the Netherlands. Requests for Reprints: Dyde A.K.C. Huysmans, MD, Department of Nuclear Medicine, De Weezenlanden Hospital, P.O. Box 10500, 8000 GM Zwolle, the Netherlands. Acknowledgments: The authors thank the technicians of the departments of Nuclear Medicine, Radiology, and Pulmonary Medicine for their assistance; the nursing staff of unit E30 for their care of the patients; and Professor H. Folgering and Dr. J. Festen for their advice.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;121(10):757-762. doi:10.7326/0003-4819-121-10-199411150-00005
Text Size: A A A

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.


Grahic Jump Location
Figure 1.
Thyroid volume (left), maximal deviation of the tracheal center from the midline (middle), and smallest cross-sectional area of the tracheal lumen (SCAT) (right) measured before and 1 year after radioiodine therapy in 19 patients with a large, compressive multinodular goiter.

Data are expressed as percentages of pretreatment values.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Patient 17 before and 1 year after treatment with 5.

6 GBq (150 mCi) of Iodine-131. Note the distended neck veins and edematous face as signs of compression of the superior vena cava before therapy (A) and their improvement 1 year after therapy (B). Published by permission of patient.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.