A 30-year perspective on radioiodine therapy of benign nontoxic multinodular goiter^*

Abstract

Purpose of review 

There is no consensus on the ideal treatment of patients with a benign nontoxic multinodular goiter. In some European countries, ¹³¹I therapy has replaced surgery as the treatment of choice in these patients. Recombinant human thyrotropin (rhTSH) is a very potent stimulator of the thyroid gland and this review focuses on rhTSH-stimulated ¹³¹I therapy.

Recent findings 

The concept of rhTSH-stimulated ¹³¹I therapy has been tested in several trials during the last 8 years. With this treatment, the goiter reduction is improved by 35–55%, compared with ¹³¹I therapy without rhTSH stimulation. RhTSH prestimulation is particularly beneficial in patients with very large goiters and in those with a low baseline thyroid ¹³¹I uptake. In addition, this therapy facilitates tracheal decompression leading to improved respiratory function. RhTSH-stimulated ¹³¹I therapy results in a higher rate of permanent hypothyroidism, whereas other side-effects are very modest when using a rhTSH dose of 0.1 mg or below.

Summary 

RhTSH-stimulated radioiodine therapy of benign nontoxic multinodular goiter is still an off-label use but several trials have shown that this treatment is significantly more effective than ¹³¹I therapy without rhTSH. However, no trial has yet compared ¹³¹I therapy and surgery head-to-head, and future trials should include evaluation of quality of life and cost.