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Recombinant Human Thyrotropin as Adjuvant in the Treatment of Multinodular Goiters with Radioiodine

Instituto de Diabetes e Endocrinologia de Maringá (C.C.A.), Maringá 87013-010 Brazil; Serviço de Endocrinologia e Metabologia do Hopital de Clínicas da Universidade Federal do Paraná (C.O.M.J., H.G.), Brazil; Núcleo de Bioestatística da Pontifícia Universidade Católica do Paraná (M.O.), Centro de Medicina Nuclear (C.E.U., L.C.W.), Centro de Tomografia Computadorizada (C.A.G.), and Serviço de Ecocardiografia da Universidade Federal do Paraná (A.M.S.), Curitiba 80810-070, Brazil

Address all correspondence and requests for reprints to: Hans Graf, Federal University of Parana, Internal Medicine, Solimoes Street 1184 Curitiba PR, Brazil 80810-070. E-mail hansgraf{at}bsi.com.br.

The use of ¹³¹I in the treatment of multinodular goiters (MNG) is well established. We evaluated the effect of 30 µCi ¹³¹I (1.11 GBq) in 18 patients with MNG with the aid of two injections of 0.1 mg recombinant human TSH (rhTSH), given on d 1 and 2. A dose of 30 µCi ¹³¹I was given on d 3. TSH, T₃, free T₄, and thyroglobulin were measured on d 1, 2, 3, 5, 10, 30, 60, 90, and 180, and antithyroid antibodies were measured on d 1, 30, 90, and 180. Twenty-four-hour ¹³¹I uptake measured 1–3 months before rhTSH increased from 12.3 ± 6.2 to 53.5 ± 10.9% (P < 0.0001), free T₄ from 1.3 ± 0.2 to peak 3.2 ± 1.1 ng/dl levels (P < 0.0001), T₃ from 113.9 ± 35.0 to peak 332.2 ± 123.0 ng/dl levels (P < 0.0001), TSH from 0.76 ± 0.71 to peak 18.9 ± 5. 3 mU/liter levels (P < 0.0001), and thyroglobulin from 280.9 ± 370.0 to peak 1838.5 ± 1360.7 ng/dl levels (P = 0.001). Painful thyroiditis (33%) and mild thyrotoxicosis (39%) constituted minor side effects. There were no changes in echocardiographic parameters, done before and after rhTSH administration, on d 3. Hypothyroidism developed in 65%. Mean goiter size, measured by computed tomography, decreased from 97.9 ± 45.4 to 65.5 ± 47.3 ml (P < 0.0001; reduction: 39 ± 19%) after 6 months. We conclude that rhTSH is a safe and efficient therapeutic tool in the treatment of MNG allowing the use of outpatient therapeutic ¹³¹I doses.

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