Radioiodine — an attractive alternative to surgery in large non-toxic multinodular goitres

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.