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Non-surgical approach to the benign nodular goiter: new opportunities by recombinant human TSH-stimulated 131I-therapy

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Abstract

The optimal treatment strategy in a goiter patient depends—among other factors—on goiter size, the degree of cosmetic or compressive symptoms, the age of the patient, the impact on the upper airways, the wish to maintain normal thyroid function, the ability of the thyroid gland to take up 131I, and the possibility of thyroid malignancy. When treatment is warranted in a patient with benign goiter, the choice usually stands between surgery and 131I-therapy. Focal destructive treatment, by ethanol sclerotherapy or interstitial laser photocoagulation, may be considered in patients with a solitary benign nodule. If thyroid hyperfunction due to nodular autonomy is the dominant problem, life-long anti-thyroid drug treatment may be relevant in elderly individuals. With the advent of recombinant human TSH (rhTSH) stimulation the goiter reduction following 131I-therapy is significantly enhanced and this treatment is of particular benefit, as compared with conventional 131I-therapy, in patients with a low baseline thyroid 131I uptake and a large goiter. If the rhTSH dose does not exceed 0.1 mg the risk of temporary hyperthyroidism and acute thyroid swelling is low. Since patient satisfaction seemingly is not improved by the greater goiter reduction obtained by rhTSH-stimulated 131I-therapy, and permanent hypothyroidism is more frequent, it may be more relevant to reduce the administered radioactivity equivalent to the rhTSH-induced increase in the thyroid 131I uptake. Future large-scale well-controlled studies should explore this strategy, with focus on cost-benefit and quality of life. A major hindrance of widespread and routine use of rhTSH-stimulated 131I-therapy is its present status as an off-label treatment.

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Acknowledgments

We would like to thank the Novo Nordic Foundation, The Agnes and Knut Mørk Foundation, The National Thyroid League, The A.P. Møller Relief Foundation, The Institute of Clinical Research (University of Southern Denmark), The Hans Skouby and wife Emma Skouby Foundation, Dagmar Marshall’s Foundation, Oda Pedersens Research Foundation, and King Christian the X’s Foundation for supporting our clinical trials in this field over the last decade. Viveque E. Nielsen is thanked for her role in a number of our rhTSH-studies. This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Conflict of interest

S.J.B. and S.F. have nothing to declare. L.H is an advisory board member and has received consultancy fees from Genzyme Corporation, Cambridge, MA, USA.

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  1. Department of Endocrinology, Odense University Hospital, 5000, Odense C, Denmark

    Steen Joop Bonnema, Søren Fast & Laszlo Hegedüs

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  1. Steen Joop Bonnema
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  2. Søren Fast
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  3. Laszlo Hegedüs
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Correspondence to Steen Joop Bonnema.

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Bonnema, S.J., Fast, S. & Hegedüs, L. Non-surgical approach to the benign nodular goiter: new opportunities by recombinant human TSH-stimulated 131I-therapy. Endocrine 40, 344–353 (2011). https://doi.org/10.1007/s12020-011-9542-6

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  • DOI: https://doi.org/10.1007/s12020-011-9542-6

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