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Related Experiment Video

Updated: Mar 22, 2026

Minimal Invasive Resection of Large Retrosternal Thyroid Goiter
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Large Multinodular Toxic Goiter: Is Surgery Always Necessary?

Roberto Negro1, Gabriele Greco1

  • 1Division of Endocrinology, "V. Fazzi" Hospital, Piazza F. Muratore, 73100 Lecce, Italy.

Case Reports in Endocrinology
|April 22, 2016
PubMed
Summary

Laser ablation treatment (LAT) followed by radioiodine-131 (131I) effectively treated a patient with large multinodular toxic goiter. This combined approach offered a viable alternative to surgery for managing hyperthyroidism and compressive symptoms.

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Area of Science:

  • Endocrinology
  • Nuclear Medicine
  • Oncology

Background:

  • Multinodular toxic goiter (MNTG) presents treatment challenges, particularly with large hyperfunctioning nodules.
  • Thyroidectomy and radioiodine-131 (131I) therapy are standard treatments, but surgery may be preferred for large volumes.
  • Large MNTG can be refractory to single-dose 131I therapy, necessitating alternative or combined strategies.

Purpose of the Study:

  • To evaluate the efficacy of laser ablation treatment (LAT) preceding 131I therapy for MNTG.
  • To assess the combined approach's impact on hyperthyroidism, nodule volume, and compressive symptoms.
  • To present a case study demonstrating an alternative to surgery for complex MNTG cases.

Main Methods:

  • A 71-year-old male with MNTG and thyrotoxicosis, who refused surgery, was treated.
  • Initial treatment involved a 600 MBq dose of 131I, which proved insufficient.
  • The patient then underwent LAT for both nodules, followed by a 400 MBq dose of 131I.

Main Results:

  • The initial 131I dose did not resolve hyperthyroidism or compressive symptoms.
  • LAT resulted in significant shrinkage of the thyroid nodules.
  • The subsequent 131I dose successfully cured hyperthyroidism, reduced nodule volume, and alleviated compressive symptoms.

Conclusions:

  • Radioiodine-131 therapy preceded by laser ablation treatment is a viable alternative to surgery for MNTG.
  • This combined modality effectively manages hyperthyroidism and compressive symptoms in patients with large, coexisting hot nodules.
  • The case highlights the potential of minimally invasive techniques in conjunction with established therapies for complex thyroid disorders.