Outpatient management of patients with large multinodular goitres treated with fractionated radioiodine |
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Authors: | Douglas M Howarth Martin T Epstein Paul A Thomas Leonard W Allen Rachel Akerman Linda Lan |
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Institution: | (1) Department of Nuclear Medicine, John Hunter Hospital, Newcastle, NSW. Australia, AU;(2) Department of Endocrinology, John Hunter Hospital, Newcastle, NSW, Australia, AU |
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Abstract: | The efficacy of fractionated out-patient radioiodine therapy in 38 patients with compressive symptoms due to long-standing
large multinodular goitres was assessed. The diagnosis was established by clinical assessment in addition to technetium-99m
pertechnetate thyroid scan or computed tomography scan of the thyroid and mediastinum. Oral iodine-131 therapy was administered
as a 2.22 GBq (60 mCi) cumulative dose over 4 months (555 MBq per month). All patients were monitored with serum thyroid-stimulating
hormone and free thyroxine (± free tri-iodothyronine) assays before the treatment and after each dose fraction. Clinical and
biochemical follow-up was performed on all patients and ranged from 6 to 45 months after therapy. The patients consisted of
35 female and three male patients with a median age of 59 years (range 37–87 years). Prior to treatment 20 patients were biochemically
hyperthyroid and 18 were euthyroid. Overall, 71% of patients reported a subjective improvement in compressive symptoms and
29% reported no change. Clinically assessed reduction in goitre size occurred in 92% of patients while there was no change
in 8%. At 3 months of follow-up, 31% of patients had become hypothyroid and at 18 months 66% were hypothyroid. Seven hyperthyroid
patients (35%) became euthyroid and 13 hyperthyroid patients (65%) became hypothyroid. Three patients who became hypothyroid
experienced neck soreness (transient in one patient, persistent in two patients). There were no differences in outcome between
patients who were hyperthyroid and those who were euthyroid prior to treatment. Fractionated out-patient radioiodine therapy
showed excellent short- and medium-term safety, was very well tolerated and offered a satisfactory alternative treatment to
surgery.
Received 23 May and in revised form 11 August 1997 |
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Keywords: | : Multinodular goitre Radioiodine Hyperthyroidism Fractionated therapyIntroduction |
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