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Cardiovascular assessment of hyperthyroid patients with multinodular goiter before and after radioiodine treatment preceded by stimulation with recombinant human TSH

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Abstract

Treatment of large multinodular goiter (MNG) with radioiodine preceded by recombinant human thyrotropin (0.1 mg rhTSH) has been shown to be a safe alternative for patients with comorbidities that preclude surgery. However, the increase in serum thyroid hormones that follows both treatments may be harmful for some patients, particularly those with underlying cardiovascular disease. In this study, we evaluated cardiac parameters (clinical, ECG, 24-h Holter, Doppler echocardiogram, treadmill stress test) in 27 of 42 patients (ages 42–80 years) with large MNGs who were treated with rhTSH before receiving 30 mCi radioiodine therapy. At baseline, 18 patients had subclinical and six patients had overt iodine-induced hyperthyroidism. All patients had a transient surge in serum levels of free T4 and total T3 into the hyperthyroid range after therapy. However, repeated cardiac evaluation did not show significant changes as compared with baseline evaluation. In conclusion, rhTSH stimulated RAI treatment of MNG did not affect structural and functional parameters of the heart, despite transient high-serum levels of thyroid hormones.

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Acknowledgments

We gratefully acknowledge the work of Ana Luiza Galrão for the urinary iodine concentration studies. We extend our gratitude to Carlos Buchpiguel and Tomoko Watanabe from the Nuclear Medicine Center, Dept. of Radiology. The cardiologic evaluation was conducted with the help of Denise Cardoso Pantaleon M.D. and Alfonso Barbato M.D. to whom we express our gratitude. Funding: This work was supported by a Research Grant from FAPESP 02/06892–6 (Sao Paulo State Research Foundation) and by partial financial support from “Instituto da Tiróide”, Sao Paulo, Brazil.

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Authors and Affiliations

  1. Thyroid Unit, Division of Endocrinology, Department of Medicine, University of Sao Paulo Medical School, Sao Paulo, 01246-000, Brazil

    Maria Fernanda Barca, Rossana Romão, Maria Silvia Cárdia, Ileana Rubio, Meyer Knobel & Geraldo Medeiros-Neto

  2. Instituto do Coração (INCOR), University of Sao Paulo Medical School, Sao Paulo, 01246-000, Brazil

    Cesar Gruppi & Mucio T. Oliveira

Authors
  1. Maria Fernanda Barca
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  2. Cesar Gruppi
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  3. Mucio T. Oliveira
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  4. Rossana Romão
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  5. Maria Silvia Cárdia
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  6. Ileana Rubio
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  7. Meyer Knobel
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  8. Geraldo Medeiros-Neto
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Correspondence to Geraldo Medeiros-Neto.

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Barca, M.F., Gruppi, C., Oliveira, M.T. et al. Cardiovascular assessment of hyperthyroid patients with multinodular goiter before and after radioiodine treatment preceded by stimulation with recombinant human TSH. Endocr 32, 175–181 (2007). https://doi.org/10.1007/s12020-007-9020-3

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  • DOI: https://doi.org/10.1007/s12020-007-9020-3

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