Radioiodine for nontoxic multinodular goiter

Area of Science:

• Endocrinology
• Nuclear Medicine
• Radiology

Background:

• Surgery is the standard treatment for nontoxic goiter but carries risks, especially for elderly patients or those with cardiopulmonary issues.
• Interest in radioactive iodine (131I) therapy for nontoxic goiter has grown due to surgical risks.
• Accurate thyroid volume measurement is crucial for treatment assessment.

Purpose of the Study:

• To evaluate the efficacy and safety of 131I therapy for nontoxic goiter.
• To compare 131I therapy with surgical intervention, particularly in high-risk patient groups.

Main Methods:

• Utilized ultrasonography and magnetic resonance imaging (MRI) for precise thyroid volume measurements.
• Assessed changes in thyroid volume and compressive symptoms post-131I therapy.
• Analyzed complication rates, including radiation thyroiditis, hyperthyroidism, hypothyroidism, and cancer risk.

Main Results:

• 131I therapy achieved a mean thyroid volume reduction of 40% at 1 year and 50-60% at 3-5 years.
• Significant improvement in compressive symptoms, including decreased tracheal compression (measured by MRI), was observed.
• Common side effects like radiation thyroiditis were mild. Complications included new-onset hyperthyroidism (approx. 5%) and hypothyroidism (approx. 20-30% at 5 years).
• Estimated lifetime cancer risk for elderly patients receiving 1.9 +/- 0.9 GBq of 131I was ~0.5%.

Conclusions:

• 131I therapy is an effective treatment for reducing nontoxic goiter volume and associated compressive symptoms.
• For elderly patients, especially those with cardiopulmonary disease, 131I therapy offers a favorable risk-benefit profile compared to surgery.
• Treatment decisions should carefully weigh the risks of both surgery and radioiodine therapy, considering patient age and comorbidities.