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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 and Author 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
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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.

Figures

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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.

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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.

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