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Birte Nygaard, MD, PhD; Laszlo Hegedüs, MD, PhD; Peter Ulriksen, MD; Kamilla Gerhard Nielsen, MD; Jens Mølholm Hansen, MD

Arch Intern Med. 1999;159:1364-1368.

Background  Radiolabeled iodine 131 therapy is used for treatment of multinodular toxic goiter, but long-term follow-up studies are lacking.

Methods  A prospective study of 130 consecutive patients (115 women) treated with ¹³¹I for multinodular toxic goiter and followed by evaluation of thyroid volume (determined using ultrasound) and thyroid function variables.

Results  The patients were observed for a median of 72 months (range, 12-180 months). Sixty-six patients received antithyroid drug pretreatment; 64 did not. Iodine 131 treatment (3.7 MBq/g thyroid tissue corrected to a 100% 24-hour ¹³¹I uptake) was given as a single dose in 81 patients, 2 doses in 38, and 3 to 5 doses in 11. One or 2 treatments cured 119 patients (92%), and 68 (52%) became euthyroid within 3 months after 1 ¹³¹I treatment. The median ¹³¹I dose was 370 MBq (range, 93-1850 MBq). Forty-nine patients needing more than 1 ¹³¹I dose had a reduction in median thyroid volume from 56 mL (range, 21-430 mL) to 44 mL (range, 15-108 mL), representing a 24% reduction related to the insufficient ¹³¹I dose. In all patients, the initial median thyroid volume of 44 mL (range, 16-430 mL) decreased to 25 mL (range, 8-120 mL) (P<.005), representing a median reduction of 43%, 24 months after the last ¹³¹I dose. Hypothyroidism evaluated using life-table analysis developed in 6% of patients who did not receive antithyroid pretreatment and 20% who did (P<.005) after a median of 42 months (range, 3-60 months), the total hypothyroidism frequency being 14% within 5 years of treatment.

Conclusions  Ninety-two percent of patients with multinodular toxic goiter were cured with 1 or 2 treatments. The thyroid volume was reduced by 43%, with few side effects. Iodine 131 should be the choice of treatment in patients with multinodular toxic goiter.

From the Departments of Endocrinology and Ultrasound, Herlev Hospital, University of Copenhagen, Herlev (Drs Nygaard, Ulriksen, Nielsen, and Hansen); and Endocrinology, Odense University Hospital, Odense (Dr Hegedüs), Denmark.

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