scholarly journals Transient Goiter Enlargement after Administration of 0.3 mg of Recombinant Human Thyrotropin in Patients with Benign Nontoxic Nodular Goiter: A Randomized, Double-Blind, Crossover Trial

2006 ◽  
Vol 91 (4) ◽  
pp. 1317-1322 ◽  
Author(s):  
Viveque Egsgaard Nielsen ◽  
Steen J. Bonnema ◽  
Laszlo Hegedüs
Keyword(s):  
Isotonic Saline ◽  
Thyroid Volume ◽  
Nodular Goiter ◽  
Random Order ◽  
Placebo Treatment ◽  
131I Therapy ◽  
Free T4 ◽  
Double Blind ◽  
Recombinant Human Thyrotropin ◽  
Double Blinded

Background: Recombinant human (rh) TSH, in doses from 0.01 to 0.9 mg, has been used to augment the effect of radioiodine (131I) therapy in patients with a benign nontoxic nodular goiter. Transient thyroid enlargement and thyrotoxicosis may be seen following 131I therapy. Aim: The aim of the study was to investigate whether rhTSH per se causes goiter enlargement, until now an issue evaluated only in healthy nongoitrous subjects. Methods: In random order, 10 patients with nontoxic nodular goiter [mean 39.8 ± 20.5 (sd) ml] received either 0.3 mg rhTSH or isotonic saline in a double-blinded crossover design. Thyroid volume (by ultrasound) and function were closely monitored during the following 28 d. Results: Saline injection did not affect thyroid function or size. After rhTSH, median serum TSH increased from baseline 0.97 mU/liter (range 0.39–1.56) to 37.0 mU/liter (range 18.5–55.0) at 24 h (P < 0.01), with a subsequent decline to subnormal levels at d 7. Mean free T4 and free T3 increased significantly from baseline to a maximum at 48 h. Twenty-four hours after rhTSH, the mean goiter volume was significantly increased by 9.8 ± 2.3% (sem) (P = 0.01) and after 48 h by 24.0 ± 5.1% (P = 0.002). The goiter enlargement had reverted at d 7. Nine patients had symptoms of hyperthyroidism and/or cervical compression after rhTSH, as opposed to one during placebo treatment (P < 0.02). Conclusions: A transient average goiter enlargement of up to 24% is seen after 0.3 mg rhTSH. This may lead to a significant cervical compression when used for augmentation of 131I therapy in patients with goiter. The use of lower doses of rhTSH needs to be explored.

scholarly journals Continuous Methimazole Therapy and Its Effect on the Cure Rate of Hyperthyroidism Using Radioactive Iodine: An Evaluation by a Randomized Trial

2006 ◽  
Vol 91 (8) ◽  
pp. 2946-2951 ◽  
Author(s):  
Steen Joop Bonnema ◽  
Finn Noe Bennedbæk ◽  
Annegrete Veje ◽  
Jens Marving ◽  
Laszlo Hegedüs
Keyword(s):  
Thyroid Volume ◽  
Nodular Goiter ◽  
131I Therapy ◽  
Cure Rate ◽  
Free T4 ◽  
Toxic Nodular Goiter ◽  
131I Uptake ◽  
Concomitant Reduction ◽  
Duration Of Disease ◽  
Continuous Use

Abstract Background: A randomized clinical trial was performed to clarify whether continuous use of methimazole (MTZ) during radioiodine (131I) therapy influences the final outcome of this therapy. Design: Consecutive patients with Graves’ disease (n = 30) or a toxic nodular goiter (n = 45) were rendered euthyroid by MTZ and randomized to stop MTZ 8 d before 131I (−MTZ; n = 36) or to continue MTZ until 4 wk after 131I (+MTZ; n = 39). Calculation of the 131I activity included an assessment of the 131I half-life and the thyroid volume. Results: The 24-h thyroid 131I uptake was lower in the +MTZ group than in the −MTZ group (44.8 ± 15.6% vs. 62.1 ± 9.9%, respectively; P < 0.001). At 3 wk after therapy, no significant change in serum free T4 index was observed in the +MTZ group (109 ± 106 vs. 83 ± 28 nmol/liter at baseline; P = 0.26), contrasting an increase in the −MTZ group (180 ± 110 vs. 82 ± 26 nmol/liter; P < 0.001). The number of cured patients was 17 (44%) and 22 (61%) in the +MTZ and −MTZ groups, respectively (P = 0.17). Cured patients tended to have a lower 24-h thyroid 131I uptake (50.1 ± 13.8% vs. 56.4 ± 17.1%; P = 0.09). By adjusting for a possible interfactorial relationship through a regression analysis (variables: randomization, 24- and 96-h thyroid 131I uptake, type and duration of disease, age, gender, presence of antithyroid peroxidase antibodies, thyroid volume, dose of MTZ), only the continuous use of MTZ correlated with treatment failure (P = 0.006), whereas a low 24-h thyroid 131I uptake predicted a better outcome (P = 0.006). Conclusion: Continuous use of MTZ hinders an excessive increase of the thyroid hormones during 131I therapy of hyperthyroid diseases. However, such a strategy seems to reduce the final cure rate, although this adverse effect paradoxically is attenuated by the concomitant reduction of the thyroid 131I uptake.

scholarly journals Prevalence of thyroid diseases in patients with acromegaly: experience of a Brazilian center

2013 ◽  
Vol 57 (9) ◽  
pp. 685-690 ◽  
Author(s):  
Helena Bandeira de Melo Paiva Uchoa ◽  
Giovanna Aparecida Balarini Lima ◽  
Lívia Lugarinho Corrêa ◽  
Ana Paula Sieiro Vidal ◽  
Suzana Aquino Cavallieri ◽  
...  
Keyword(s):  
Thyroid Volume ◽  
Nodular Goiter ◽  
Needle Aspiration ◽  
Thyroid Diseases ◽  
Thyroid Disorders ◽  
Free T4 ◽  
Age Related ◽  
Igf I ◽  
Diffuse Goiter ◽  
Antibody Levels

OBJECTIVES: Acromegaly is frequently associated with thyroid diseases. In this study, we evaluated the frequency of thyroid disorders in a series of acromegalic patients. SUBJECTS AND METHODS: We evaluated 106 acromegalic patients using thyroid ultrasonography (US) and measurements of GH, IGF-I, free T4, TSH and anti-thyroperoxidase antibody levels. IGF-I was expressed in mass units and age-related standard deviation scores (SD-scores). Fine-needle aspiration biopsy (FNAB) was performed on thyroid nodules with a diameter greater than one centimeter or with suspicious characteristics. RESULTS: Thyroid disorders were found in 75 patients. Eleven patients had diffuse goiter, 42 patients had nodular goiter, and 22 patients had unspecific morphological abnormalities. Four patients (3.8%) had thyroid carcinoma. Considering the patients with diffuse or nodular goiter, thyroid volume was greater in patients with active acromegaly, and was positively correlated with GH, IGF-I, and IGF-I SD-score. CONCLUSIONS: Our study confirmed that benign thyroid diseases are frequent in acromegalic patients. The prevalence of thyroid cancer was higher than in the overall population. We suggest that thyroid US should be routinely performed in patients with acromegaly.

Recombinant human thyrotropin stimulated 131I treatment for multinodular goiter

2016 ◽  
Vol 55 (06) ◽  
pp. 228-235 ◽  
Author(s):  
Limin Tang ◽  
Tiekun Ma ◽  
Fengyu Wu
Keyword(s):  
Adverse Effects ◽  
Data Extraction ◽  
Thyroid Volume ◽  
131I Therapy ◽  
Cochrane Library ◽  
131I Treatment ◽  
Significant Difference ◽  
High Doses ◽  
Recombinant Human Thyrotropin ◽  
The Cochrane Library

SummaryThe aim of the study was to investigate the effects of rhTSH stimulation before 131I treatment in patients with MNG. Methods: Sources included the Cochrane Library, MEDLINE, EMBASE, and SCOPUS database (all until January 2016). Randomized controlled trials (RCTs) that assessed the efficacy of rhTSH-stimulated 131I treatment compared to placebo or 131I treatment alone were collected. Two authors performed the data extraction independently. Results: Six RCTs involving 294 patients with MNG were included in this review. Altogether 168 patients were randomized to rhTSH-stimulated 131I therapy, and 126 to either placebo and 131I or 131I alone. rhTSH-stimulated 131I vs placebo and 131I or 131I alone for MNG showed no statistically significant difference in quality of life and all-cause mortality. rhTSH- (at a dose of 0.03 mg and above) stimulated 131I treatment for MNG showed significant benefits in thyroid volume reduction. 131I treatment with rhTSH stimulation at high doses (0.03 mg, 0.1 mg, 0.3 mg and 0.45 mg) for MNG caused significantly higher adverse effects and hypothyroidism. Conclusions: The overall results indicated that using rhTSH at high doses of 0.03–0.45 mg before 131I therapy resulted in a greater TVR than 131I therapy alone for patients with non-toxic MNG. However, an increased incidence of adverse effects and hypothyroidism was observed in patients receiving highdose of rhTSH pretreatment than in patients who received low-dose rhTSH pretreatment. Therefore, a dose of 0.03 mg rhTSH pretreatment before 131I therapy may be more potent than 131I alone in treating patients with non-toxic MNG who either had a contraindication for or declined surgery.

scholarly journals Reduction of Thyroid Nodule Volume by Levothyroxine and Iodine Alone and in Combination: A Randomized, Placebo-Controlled Trial

2011 ◽  
Vol 96 (9) ◽  
pp. 2786-2795 ◽  
Author(s):  
M. Grussendorf ◽  
C. Reiners ◽  
R. Paschke ◽  
K. Wegscheider
Keyword(s):  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Controlled Trial ◽  
Thyroid Volume ◽  
Nodular Goiter ◽  
Target Range ◽  
University Hospitals ◽  
Double Blind ◽  
End Point ◽  
Nodule Volume

Abstract Context: Nodular goiter is common worldwide, but there is still debate over the medical treatment. Objective: The objective of the study was the measurement of the effect of a treatment with (nonsuppressive) T4, iodine, or a combination of both compared with placebo on volume of thyroid nodules and thyroid. Design: This was a multicenter, randomized, double-blind trial in patients with nodular goiter in Germany [LISA (Levothyroxin und Iodid in der Strumatherapie Als Mono-oder Kombinationstherapie) trial]. Setting: The study was conducted in outpatient clinics in university hospitals and regional hospitals and private practices. Participants: One thousand twenty-four consecutively screened and centrally randomized euthyroid patients aged 18–65 yr with one or more thyroid nodules (minimal diameter 10 mm) participated in the study. Intervention: Intervention included placebo, iodine (I), T4, or T4+I for 1 yr. T4 doses were adapted for a TSH target range of 0.2–0.8 mU/liter. Outcome Measures: The primary end point was percent volume reduction of all nodules measured by ultrasound, and the main secondary end point was a change in goiter volume. Results: Nodule volume reductions were −17.3% [95% confidence interval (CI) −24.8/−9.0%, P < 0.001] in the T4+I group, −7.3% (95% CI −15.0/+1.2%, P = 0.201) in the T4 group, and −4.0% (95% CI −11.4/+4.2%, P = 0.328) in the I group as compared with placebo. In direct comparison, the T4+I therapy was significantly superior to T4 (P = 0.018) or I (P = 0.003). Thyroid volume reductions were −7.9% (95% CI −11.8/−3.9%, P < 0.001), −5.2% (95% CI −8.7/−1.6%, P = 0.024) and −2.5% (95% CI −6.2/+1.4%, P = 0.207), respectively. The T4+I therapy was significantly superior to I (P = 0.034) but not to T4 (P = 0.190). Conclusion: In a region with a sufficient iodine supply, a 1-yr therapy with a combination of I and T4 with incomplete suppression of thyrotropin reduced thyroid nodule volume further than either component alone or placebo.

scholarly journals Success Rate of Radioiodine Therapy in Graves’ Disease: The Influence of Thyrostatic Medication

1999 ◽  
Vol 84 (4) ◽  
pp. 1229-1233 ◽  
Author(s):  
Osama Sabri ◽  
Michael Zimny ◽  
Gernot Schulz ◽  
Mathias Schreckenberger ◽  
Patrick Reinartz ◽  
...  
Keyword(s):  
Success Rate ◽  
Standard Dose ◽  
Thyroid Volume ◽  
Absorbed Dose ◽  
131I Therapy ◽  
Stepwise Logistic Regression ◽  
Graves Disease ◽  
Free T4 ◽  
Absorbed Doses ◽  
Receptor Antibodies

There is controversy whether simultaneous thyrostatic medication influences the outcome of radioiodine (131I) therapy in Graves’ disease by reducing the absorbed energy dose of 131I when delivering a standard dose. We therefore sought to ascertain whether the outcome of ablative 131I therapy is in any way affected by simultaneous thyrostasis (carbimazole) by aiming for a constant absorbed dose of 200–250 Gy. We prospectively studied 207 patients with Graves’ disease (106 with and 101 without simultaneous carbimazole at the time of 131I therapy). All patients were reexamined 3, 6, and 12 months after 131I therapy. The 101 nonthyrostatic patients showed a highly significantly greater success rate (93%) than the 106 thyrostatic patients (49%). Stepwise logistic regression demonstrated that failure was related to the administration of carbimazole during 131I therapy (P < 0.00005) and the absorbed dose (P < 0.025), but was not related to free T3, free T4, TSH receptor antibodies, or thyroid volume. The success rate was 100% in 93 nonthyrostatic patients with absorbed doses of 200 Gy or more, but was only 12.5% (1 of 8) for absorbed doses less than 200 Gy. Correlation between success and absorbed dose was significantly higher for nonthyrostatic than for thyrostatic patients (r = 0.93 vs. r = 0.24). Sixteen patients who discontinued thyrostasis 1–3 days before 131I therapy showed 94% successes. Simultaneous thyrostasis is the decisive factor against a successful 131I therapy even if the significantly reduced 131I uptake/half-life values under thyrostasis are compensated with a higher delivered dose to ensure a comparable absorbed dose, possibly due to the additionally effective radioprotective properties of carbimazole. Therefore, if clinically feasible, we recommend discontinuing thyrostasis at least 1 day before beginning 131I therapy, because even in hyperthyroid nonthyrostatic patients the success rate was 100%.

scholarly journals Administration of a Single Low Dose of Recombinant Human Thyrotropin Significantly Enhances Thyroid Radioiodide Uptake in Nontoxic Nodular Goiter1

2000 ◽  
Vol 85 (10) ◽  
pp. 3592-3596 ◽  
Author(s):  
Dyde A. Huysmans ◽  
Willy-Anne Nieuwlaat ◽  
Ronald J. Erdtsieck ◽  
Andries P. Schellekens ◽  
Jo W. Bus ◽  
...  
Keyword(s):  
Low Dose ◽  
Nodular Goiter ◽  
Peak Level ◽  
Serum Levels ◽  
High Dose ◽  
Free T4 ◽  
Contrast Administration ◽  
Recombinant Human Thyrotropin ◽  
Serum Tsh ◽  
Tsh Levels

Radioiodine (131I) is increasingly used as treatment for volume reduction of nontoxic, nodular goiter. A high dose of 131I is often needed because of low thyroid radioiodide uptake (RAIU). We investigated whether pretreatment with a single, low dose of recombinant human TSH (rhTSH; Thyrogen, Genzyme Transgenics Corp.) enhances RAIU in 15 patients with nontoxic, nodular goiter (14 women and 1 man; aged 61 ± 11 yr). Four patients were studied twice, and 1 patient was studied 3 times. RAIU was measured both under basal conditions and after pretreatment (im) with rhTSH, given either 2 h (0.01 mg; n = 7) or 24 h[ 0.01 mg (n = 7) or 0.03 mg (n = 7)] before 131I administration (20–40 μCi). Serum levels of TSH, free T4 (FT4), and total T3 were measured at 2, 5, 8, 24, 48, 72, 96, and 192 h after rhTSH administration. After administration of 0.01 mg rhTSH, serum TSH rose from 0.7 ± 0.5 to a peak level of 4.4 ± 1.1 mU/L (P < 0.0001), FT4 rose from 16.0 ± 2.6 to 18.5 ± 3.7 pmol/L (P < 0.0001), and T3 rose from 2.10 ± 0.41 to 2.63 ± 0.66 nmol/L (P < 0.0001). After administration of 0.03 mg rhTSH, TSH rose from 0.6± 0.4 to 15.8 ± 2.3 mU/L (P < 0.0001), FT4 rose from 15.2 ± 1.5 to 21.7 ± 2.9 pmol/L (P < 0.0001), and T3 rose from 1.90 ± 0.43 to 3.19 ± 0.61 nmol/L (P < 0.0001). Peak TSH levels were reached at 5–8 h and peak FT4 and T3 levels at 8–96 h after rhTSH administration. Administration of 0.01 mg rhTSH 2 h before 131I increased 24-h RAIU from 30 ± 11% to 42 ± 10% (P < 0.02), 0.01 mg rhTSH administered 24 h before 131I increased 24-h RAIU from 29 ± 10% to 51 ± 10% (P < 0.0001), and 0.03 mg rhTSH administered 24 h before 131I increased 24-h RAIU from 33 ± 11% to 63 ± 9% (P < 0.0001). After administration of 0.01 mg rhTSH 2 h before 131I, 24-h RAIU did not increase in 1 patient, whereas the increase in 24-h RAIU was less than 10% in 2 other patients. In contrast, administration of rhTSH 24 h before 131I increased 24-h RAIU by more than 10% in all 14 patients (by >20% in 10 and by> 30% in 6). In conclusion, pretreatment with a single, low dose of rhTSH in patients with nontoxic, nodular goiter increased RAIU considerably. Our observations hold promise that administration of rhTSH before 131I therapy for nontoxic, nodular goiter will allow treatment with lower doses of 131I in these patients.

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