The Feasibility of High Dose Iodine 131 Treatment as an Alternative to Surgery in Patients with a Very Large Goiter: Effect on Thyroid Function and Size and Pulmonary Function*

Bonnema, Steen J.; Bertelsen, Henrik; Mortensen, Jesper; Andersen, Peter B.; Knudsen, Dorthe U.; Bastholt, Lars; Hegedüs, Laszlo

doi:10.1210/jcem.84.10.6052

Cited by 157Thyroid and Parathyroid SurgeryThyroid Disorders and TreatmentsThyroid Cancer Diagnosis and Treatment

The Feasibility of High Dose Iodine 131 Treatment as an Alternative to Surgery in Patients with a Very Large Goiter: Effect on Thyroid Function and Size and Pulmonary Function*

Bonnema, Steen J., Bertelsen, Henrik, Mortensen, Jesper, Andersen, Peter B., Knudsen, Dorthe U., Bastholt, Lars, Hegedüs, Laszlo·1999·The Journal of Clinical Endocrinology & Metabolism

DOI 10.1210/jcem.84.10.6052

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Abstract

Some patients with very large goiters (>150 mL) are not candidates for surgery. We evaluated the feasibility of high dose 131I in such patients. Twenty-three patients (2 men and 21 women; median age, 67 yr; range, 42–86 yr) with very large goiter (8 toxic) were treated with calculated high dose 131I [median, 2281 megabecquerels (61.6 mCi); range, 988-4620 megabecquerels (26.7–124.9 mCi)]. During the 12-month observation period, goiter reduction and tracheal anatomy were monitored by magnetic resonance imaging, and the respiratory capacity was monitored by pulmonary function tests. Five patients (22%) developed hypothyroidism. Thyroid volumes were at baseline, after 1 week, and after 1 yr [mean ± sem, 311 ± 28, 314 ± 26 (P = NS), and 215 ± 26 (P < 0.01) mL]. The relative changes 1 week after therapy ranged from −14.1% to 15.3%. After 1 yr the mean size was reduced by 33.9% (range, 13.5–61.4%). Only the initial goiter size showed a significant negative correlation to the percent reduction. The smallest cross-sectional area of the trachea decreased 9.2% within 1 week after treatment, but eventually emerged with a 17.9% larger area [mean ± sem, 84.3 ± 4.8, 75.5 ± 5.1 (P < 0.01), and 98.2 ± 6.0 (P < 0.01) mm2]. The inspiratory parameter, FIF50%, improved after an initial insignificant decline[ baseline therapy, after 1 week, after 3 months, and after 1 yr (mean ± sem), 2.37 ± 0.24, 2.20 ± 0.21 (P = NS), 2.51 ± 0.23 (P= NS), and 2.76 ± 0.25 (P = 0.01) L/s]. FIF50% correlated significantly with the smallest cross-sectional tracheal area (baseline, 1 week, and 1 yr: r = 0.74; P < 0.001, r = 0.63; P < 0.005, and r = 0.46; P < 0.05). Changes in tracheal anatomy did not correlate with changes in either lung dynamics or goiter size. In conclusion, very large goiters can be reduced by a third, on the average, with high dose 131I therapy without any initial clinically significant tracheal compression. Tracheal cross-sectional area as well as pulmonary inspiratory capacity improve. No serious adverse effects are seen.

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Very large goiters treated with high-activity RAI only decrease in size by 30%-50%.
“This outcome may be due in part to the fact that very large goiters treated with highactivity RAI only decrease in size by 30%-50% (253).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [253]

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Authors: Bonnema, S. J., Bertelsen, H., Mortensen, J., Andersen, P. B., Knudsen, D. U., Bastholt, L., & Hegedüs, L.
Affiliations: Departments of Endocrinology (S.J.B., L.H.), DK-5000 Odense, Denmark
Nuclear Medicine (H.B., J.M.), DK-5000 Odense, Denmark
Radiology (P.B.A., D.U.K.), DK-5000 Odense, Denmark
Odense University Hospital (DK)
Corresponding author: Bonnema, Steen J.
ORCID: Bonnema, Steen J.
Mortensen, Jesper
Bastholt, Lars
Venue: The Journal of Clinical Endocrinology & Metabolism
Publisher: The Endocrine Society
Published: 1999-10-01
Volume: 84
Issue: 10
Pages: 3636-3641
ISSN: 0021-972X (ISSN-L)
1945-7197
DOI: 10.1210/jcem.84.10.6052
OpenAlex: W2137726532
Cited by: 157
References: 32
Citations by year: 2026: 1 · 2024: 6 · 2023: 4 · 2022: 6 · 2021: 2 · 2020: 7 · 2019: 4 · 2018: 3 · 2017: 7 · 2016: 5 · 2015: 7 · 2014: 6 · 2013: 2 · 2012: 6
FWCI: 3.45
Type: journal article
Language: en
Open access: closed
Locations: The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
PubMed (publishedVersion)
University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion)
Topics: Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
Keywords: iodine-131 therapy, conservative treatment, thyroid volume, tracheal compression, tracheal cross-sectional area, lung function, inspiratory flow, hypothyroidism, thyroid function, magnetic resonance imaging, radioiodine therapy, respiratory capacity, inspiratory capacity
MeSH terms: Adult, Aged, Aged, 80 and over, Dose-Response Relationship, Radiation, Feasibility Studies, Female, Goiter, Humans, Inspiratory Capacity, Iodine Radioisotopes, Lung, Male, Middle Aged, Radionuclide Imaging, Respiratory Function Tests, Thyroid Gland, Trachea

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The Feasibility of High Dose Iodine 131 Treatment as an Alternative to Surgery in Patients with a Very Large Goiter: Effect on Thyroid Function and Size and Pulmonary Function*

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