Vol 12, No 1 (2009)
Review paper
Published online: 2009-04-21
Radioiodine — an attractive alternative to surgery in large non-toxic multinodular goitres
Nucl. Med. Rev 2009;12(1):23-29.
Abstract
Sporadic non-toxic goitre (SNG) is defined as thyroid enlargement
in a euthyroid patient living in an area without endemic
goitre. Because thyroid hormone function is within the reference
range, the main problems are the signs of thyroid enlargement,
thus reducing the size of the goitre is undoubtedly the primary
goal of therapy. Although SNG is a common disease, there is
no single optimal management of treatment strategy. L-thyroxine
treatment, although only moderately effective and with reported
reductions in goitre volume of less than 30%, is still used.
Moreover, in patients over 60 years of age, long-term TSH-suppression
treatment may cause iatrogenic hyperthyroidism and
is associated with a significant risk of paroxysmal atrial fibrillation
as well as osteoporosis, especially in postmenopausal women.
In patients with huge goitres, the surgical removal of
a gland is made most frequently. The great advantage of thyroid
surgery is its immediate effect. Unfortunately, surgery carries
a risk of goitre recurrence and complications, both surgical and
anaesthesia-related. For those patients who do not want to be
operated on, or have contraindications for invasive treatment,
and taking into consideration the low efficacy of L-thyroxine treatment,
the best option is radioiodine. Despite encouraging reports of the high efficacy of radioiodine in the treatment of SNG
this method is still not commonly used by many clinicians. In
our work we would like to point out the efficacy, adverse effects,
and contraindications of using iodine-131. Going through the
advantages and disadvantages of all accessible methods of treatment
of SNG, we would like to focus on using radioiodine as an
attractive alternative to surgery.
Keywords: sporadic non-toxic goitremultinodular goitreradioiodine treatment