LARGE, COMPRESSIVE GOITERS TREATED WITH RADIOIODINE

Objective: To evaluate the effectiveness of radioiodine therapy as an alternative for surgery in elderly patients with a large, compressive goiter using objective methods for measuring thyroid volume and tracheal compression. Design: Prospective study. Setting: University hospital in the Netherlands. Patients: 19 patients (mean age +/- SD, 66 +/- 14 years) with a large, compressive multinodular goiter who had a high operative risk or refused to have thyroid surgery. Intervention: A single intravenous dose of I-131 at 2.6 +/- 1.0 GBq (70 +/- 28 mCi) (3.7 MBq or 100 mu Ci/g of thyroid tissue), followed by daily administration of L-thyroxine in doses that did not suppress thyroid-stimulating hormone. Measurements: Clinical evaluation and measurements of thyroid volume, maximal tracheal deviation, and the smallest cross-sectional area of the tracheal lumen with magnetic resonance imaging before and 1 year after I-131 treatment. Results: No exacerbation of compressive symptoms after I-131 therapy was observed. Thyroid volume was 269 +/- 153 mL before treatment and 154 +/- 73 mL 1 year after treatment (P < 0.001). Thyroid volume was reduced 40% +/- 15% (range, 19% to 68%). Maximal tracheal deviation (1.9 +/- 0.8 cm before and 1.5 +/- 0.7 cm 1 year after therapy) had decreased by 20% +/- 20% (range, -4% to 73%; P < 0.001), and the smallest cross-sectional area of the tracheal lumen (0.78 +/- 0.38 cm(2) before and 1.04 +/- 0.48 cm(2) 1 year after therapy) had increased by 36% +/- 38% (range, -3% to 125%; P < 0.001). Clinical signs and symptoms improved in 8 of 12 patients with dyspnea and inspiratory strider and in both patients with compression of the superior vena cava. Conclusions:Therapy with I-131 is an effective alternative to surgery for elderly patients with a large, compressive multinodular goiter.