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Serum thyroxine and age — rather than thyroid volume and serum TSH — are determinants of the thyroid radioiodine uptake in patients with nodular goiter

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Abstract

Background: Radioiodine (131|) therapy is widely used for treatment of non-toxic goiters. A limitation for this treatment is a low thyroid radioiodine uptake (RAIU), often encountered in these patients. Aim: To estimate the impact of various factors on the thyroid RAIU. Methods: We examined prospectively 170 patients (146 females; age range: 22–87 yrs) with nodular goiter (median 64 ml, range: 20–464 ml) selected for 131| therapy. Serum TSH was sub-normal in 42.4%. None were treated with anti-thyroid drugs. The thyroid RAIU was determined at 24h and 96h. The goiter volume was measured by ultrasound (no.=127), or by magnetic resonance imaging (no.=43). Results: The 24h and the 96h RAIU were 34.2±9.8(SD)% (range: 11.4–66.0%) and 34.0±10.0% (range: 10.5–60.9%), respectively. Sixty-one patients had a 24h RAIU <30% and these individuals were older than patients with a 24h RAIU ≥30% (median 58 vs 51 yrs, p=0.02). These two subgroups did not differ significantly in other variables. Overall, the 24h RAIU was positively correlated to the serum (s) free T4-index (r=0.20, p=0.01), and negatively to age (r=−0.18, p=0.02), but not significantly related to serum TSH or thyroid volume. Age correlated positively with thyroid volume (r=0.31, p<0.001). In a regression analysis, s-free T4-index and age remained as the only determinants of the 24h and the 96h RAIU. Conclusions: In patients with a symptomatic nodular goiter, serum T4 and age are the major determinants of the thyroid RAIU. A sub-normal serum TSH is not a marker of a compromised thyroid RAIU but reflects that the iodine is confined to a few ‘hot spots’.

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Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Odense University Hospital, DK-5000, Odense C, Denmark

    S. J. Bonnema MD, PhD, S. Fast, V. E. Nielsen & L. Hegedüs

  2. Department of Nuclear Medicine, Odense University Hospital, Denmark

    H. Boel-Jorgensen & P. Grupe

  3. Department of Radiology, Odense University Hospital, Denmark

    P. B. Andersen

Authors
  1. S. J. Bonnema MD, PhD
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  2. S. Fast
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  3. V. E. Nielsen
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  4. H. Boel-Jorgensen
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  5. P. Grupe
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  6. P. B. Andersen
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  7. L. Hegedüs
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Correspondence to S. J. Bonnema MD, PhD.

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Bonnema, S.J., Fast, S., Nielsen, V.E. et al. Serum thyroxine and age — rather than thyroid volume and serum TSH — are determinants of the thyroid radioiodine uptake in patients with nodular goiter. J Endocrinol Invest 34, e52–e57 (2011). https://doi.org/10.1007/BF03347076

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