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Low-dose recombinant human thyrotropin-aided radioiodine treatment of large, multinodular goiters in elderly patients

Institute of Endocrinology, ¹ Department of Radiology and ² Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

(Correspondence should be addressed to O Cohen, Institute of Endocrinology, Chaim Sheba Medical Center, Tel Hashomer, 52621, Israel; Email: ohdcohen{at}sheba.health.gov.il)

Objective: We aimed to assess low-dose recombinant human thyroid-stimulating hormone (rhTSH)-aided, fixed-activity radioiodine therapy of large, multinodular goiters (MNGs) in elderly patients with comorbidities.

Design: This was a short-term, observational study.

Methods: We measured 24-h thyroid radioiodine uptake (RAIU) of 2 µCi 131-iodine at baseline and 24 h after intramuscular injection of 0.03 mg rhTSH in 17 patients (aged 60–86 years, 12 women), who subsequently received 30 mCi 131-iodine 24 h after an identical rhTSH injection. TSH and free thyroxine (FT4) were measured at baseline and days 10, 30 and 90 after therapy. Thyroid volume was assessed by computed tomography at baseline and day 180.

Results: rhTSH, 0.03 mg, significantly increased mean 24-h thyroid RAIU from 25.8% ± 10.3% to 43.3% ± 8.4% (68% relative increase; t(16) = –8.43, P < 0.001). The proportion of patients overtly or subclinically hyperthyroid (TSH < 0.5 mU/l) decreased from 71% (12/17) at baseline to 19% (3/16) at 3 months. Mean serum FT₄ peaked at slightly above normal range, 25.9 ± 7.7 pmol/l (46% over baseline) and was 21% under baseline levels at 3 months. Mean estimated thyroid volume fell 34% from baseline to 6 months (170.0 ± 112.8 to 113.1 ± 97.5 ml; P < 0.01). Symptomatic relief, improved well-being, and/or reduction or elimination of antihyperthyroid medication were seen in 76% of patients. Three (18%) patients had transient neck pain or tenderness, or palpitations; one had transient asymptomatic thyroid enlargement; and three (18%) became hypothyroid by 3 months.

Conclusions: Intramuscular rhTSH, 0.03 mg, followed 24 h later by 30 mCi 131-iodine, is a safe, effective and convenient treatment for MNG in elderly patients with comorbidities.

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