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Long-term outcome of low-activity radioiodine administration preceded by adjuvant recombinant human TSH pretreatment in elderly subjects with multinodular goiter.

Giusti M, Caputo M, Calamia I, Bagnara M, Ceresola E, Schiavo M, Mussap M, Ferone D, Minuto F, Bagnasco M - Thyroid Res (2009)

Bottom Line: While TV was reduced in both groups, the percentage TV reduction recorded at the last examination was significantly higher (P = 0.03) in group 1 than in group 2.MNG-related complaints were significantly reduced in both group 1 (P = 0.0001 vs baseline) and group 2 (P = 0.001) patients.Low radioiodine activities after pretreatment with low-dosage rhTSH are able to reduce TV and improve MNG-related symptoms in elderly subjects.

View Article: PubMed Central - HTML - PubMed

Affiliation: Clinica Endocrinologica, Azienda Ospedaliera Universitaria "San Martino", Genoa, Italy. magius@unige.it.

ABSTRACT

Background: Large multinodular goiter (MNG) in elderly people is a common finding which can require intervention. The long-term effect of radioiodine therapy on thyroid volume (TV) and function after recombinant human (rh) TSH pre-treatment was evaluated.

Methods: After baseline evaluation, 40 subjects over 60 years old with a large MNG were treated with 131I up to the activity of 600 MBq. Nineteen patients were pretreated with rhTSH (0.1 mg on 2 consecutive days; group 1) while 21 subjects underwent treatment without rhTSH pretreatment (group 2). TV was monitored every 6-12 months by ultrasonography. The median follow-up period was 36 months.

Results: At the baseline, the groups matched in terms of TV, 24-h radioiodine uptake (RAIU), urinary iodine and neck complaints. The number of subjects pretreated with anti-thyroid drugs was significantly (P = 0.01) greater in group 2 than in group 1; TSH was more suppressed (P = 0.003) and f-T3 was more elevated (P = 0.005) in group 2 than in group 1 patients. RhTSH increased 24-h RAIU in group 1 up to the baseline level observed in group 2. The 131I activity administered was similar in both groups. Adverse events were slight and similar in both groups. A permanent post-radioiodine toxic condition was reported only in 2 patients in group 2. After radioiodine therapy, hypothyroidism was observed in significantly more group 1 patients than group 2 patients (P = 0.002). While TV was reduced in both groups, the percentage TV reduction recorded at the last examination was significantly higher (P = 0.03) in group 1 than in group 2. MNG-related complaints were significantly reduced in both group 1 (P = 0.0001 vs baseline) and group 2 (P = 0.001) patients.

Conclusion: Low radioiodine activities after pretreatment with low-dosage rhTSH are able to reduce TV and improve MNG-related symptoms in elderly subjects.

No MeSH data available.


Related in: MedlinePlus

Individual TV observed over 36 months of follow-up in group 1 (upper panel) and group 2 (lower panel) patients. Mean ± SEM data are also shown (closed circles). Significances by Dunn's multiple comparison test vs baseline are: a P < 0.01, b P < 0.05.
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Figure 1: Individual TV observed over 36 months of follow-up in group 1 (upper panel) and group 2 (lower panel) patients. Mean ± SEM data are also shown (closed circles). Significances by Dunn's multiple comparison test vs baseline are: a P < 0.01, b P < 0.05.

Mentions: At the baseline, the median TV was 71.9 ± 8.1 ml in group 1 and 79.5 ± 8.1 ml in group 2 (Table 1). Four patients from group 2 dropped out during the follow-up period: 3 underwent further RAI therapy (TV reduction 3%, 11%, and 31% from baseline) after 24 months, and 1 underwent thyroid surgery (TV reduction 30%) after 42 months. Figure 1 shows the individual and the mean (± SEM) time-course trends of TV in each group. Kruskal-Wallis analysis of variance revealed that TV reduction was greater in group 1 (P < 0.0001) than in group 2 (P = 0.01). Dunn's multiple comparison test revealed no further significant TV reduction from the 6th to the 36th month of follow-up in either group of patients (Figure 1). The average follow-up was 33.3 ± 3.2 months (median 36 months; range 12 – 60 months) in group 1 and 36.9 ± 3.4 months (median 36 months; range 12 – 63 months) in group 2 (ns). At the last evaluation, TV was 29.5 ± 5.2 ml (median 25 ml; range 1–107 ml) in group 1 (P < 0.0001 vs baseline) and 47.5 ± 8.1 ml (median 40 ml; range 10–172 ml) in group 2 (P < 0.0001 vs baseline) patients. At this evaluation, the difference in TV between the groups was near to statistical significance (P = 0.06). Figure 2 reports the mean percentage (± SEM) change in TV following RAI in both groups of subjects. The TV reduction was more evident in group 1 than in group 2 patients. At the last evaluation, the TV reduction was significantly (P = 0.03) greater in group 1 (60.2 ± 4.4%; median 62%, range 12% – 98%) than in group 2 (44 ± 5.4%; median 47%, range 0% – 84%). In both groups, TV reduction was unrelated to age, BMI, initial TV, thyroid function, baseline RAIU or RAI activity.


Long-term outcome of low-activity radioiodine administration preceded by adjuvant recombinant human TSH pretreatment in elderly subjects with multinodular goiter.

Giusti M, Caputo M, Calamia I, Bagnara M, Ceresola E, Schiavo M, Mussap M, Ferone D, Minuto F, Bagnasco M - Thyroid Res (2009)

Individual TV observed over 36 months of follow-up in group 1 (upper panel) and group 2 (lower panel) patients. Mean ± SEM data are also shown (closed circles). Significances by Dunn's multiple comparison test vs baseline are: a P < 0.01, b P < 0.05.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2713215&req=5

Figure 1: Individual TV observed over 36 months of follow-up in group 1 (upper panel) and group 2 (lower panel) patients. Mean ± SEM data are also shown (closed circles). Significances by Dunn's multiple comparison test vs baseline are: a P < 0.01, b P < 0.05.
Mentions: At the baseline, the median TV was 71.9 ± 8.1 ml in group 1 and 79.5 ± 8.1 ml in group 2 (Table 1). Four patients from group 2 dropped out during the follow-up period: 3 underwent further RAI therapy (TV reduction 3%, 11%, and 31% from baseline) after 24 months, and 1 underwent thyroid surgery (TV reduction 30%) after 42 months. Figure 1 shows the individual and the mean (± SEM) time-course trends of TV in each group. Kruskal-Wallis analysis of variance revealed that TV reduction was greater in group 1 (P < 0.0001) than in group 2 (P = 0.01). Dunn's multiple comparison test revealed no further significant TV reduction from the 6th to the 36th month of follow-up in either group of patients (Figure 1). The average follow-up was 33.3 ± 3.2 months (median 36 months; range 12 – 60 months) in group 1 and 36.9 ± 3.4 months (median 36 months; range 12 – 63 months) in group 2 (ns). At the last evaluation, TV was 29.5 ± 5.2 ml (median 25 ml; range 1–107 ml) in group 1 (P < 0.0001 vs baseline) and 47.5 ± 8.1 ml (median 40 ml; range 10–172 ml) in group 2 (P < 0.0001 vs baseline) patients. At this evaluation, the difference in TV between the groups was near to statistical significance (P = 0.06). Figure 2 reports the mean percentage (± SEM) change in TV following RAI in both groups of subjects. The TV reduction was more evident in group 1 than in group 2 patients. At the last evaluation, the TV reduction was significantly (P = 0.03) greater in group 1 (60.2 ± 4.4%; median 62%, range 12% – 98%) than in group 2 (44 ± 5.4%; median 47%, range 0% – 84%). In both groups, TV reduction was unrelated to age, BMI, initial TV, thyroid function, baseline RAIU or RAI activity.

Bottom Line: While TV was reduced in both groups, the percentage TV reduction recorded at the last examination was significantly higher (P = 0.03) in group 1 than in group 2.MNG-related complaints were significantly reduced in both group 1 (P = 0.0001 vs baseline) and group 2 (P = 0.001) patients.Low radioiodine activities after pretreatment with low-dosage rhTSH are able to reduce TV and improve MNG-related symptoms in elderly subjects.

View Article: PubMed Central - HTML - PubMed

Affiliation: Clinica Endocrinologica, Azienda Ospedaliera Universitaria "San Martino", Genoa, Italy. magius@unige.it.

ABSTRACT

Background: Large multinodular goiter (MNG) in elderly people is a common finding which can require intervention. The long-term effect of radioiodine therapy on thyroid volume (TV) and function after recombinant human (rh) TSH pre-treatment was evaluated.

Methods: After baseline evaluation, 40 subjects over 60 years old with a large MNG were treated with 131I up to the activity of 600 MBq. Nineteen patients were pretreated with rhTSH (0.1 mg on 2 consecutive days; group 1) while 21 subjects underwent treatment without rhTSH pretreatment (group 2). TV was monitored every 6-12 months by ultrasonography. The median follow-up period was 36 months.

Results: At the baseline, the groups matched in terms of TV, 24-h radioiodine uptake (RAIU), urinary iodine and neck complaints. The number of subjects pretreated with anti-thyroid drugs was significantly (P = 0.01) greater in group 2 than in group 1; TSH was more suppressed (P = 0.003) and f-T3 was more elevated (P = 0.005) in group 2 than in group 1 patients. RhTSH increased 24-h RAIU in group 1 up to the baseline level observed in group 2. The 131I activity administered was similar in both groups. Adverse events were slight and similar in both groups. A permanent post-radioiodine toxic condition was reported only in 2 patients in group 2. After radioiodine therapy, hypothyroidism was observed in significantly more group 1 patients than group 2 patients (P = 0.002). While TV was reduced in both groups, the percentage TV reduction recorded at the last examination was significantly higher (P = 0.03) in group 1 than in group 2. MNG-related complaints were significantly reduced in both group 1 (P = 0.0001 vs baseline) and group 2 (P = 0.001) patients.

Conclusion: Low radioiodine activities after pretreatment with low-dosage rhTSH are able to reduce TV and improve MNG-related symptoms in elderly subjects.

No MeSH data available.


Related in: MedlinePlus