Thiamazole as an adjuvant to radioiodine for volume reduction of multinodular goiter
Abstract
BACKGROUND: Radioiodine ((131)I) is an alternative to surgery for the treatment of multinodular goiter (MNG). Frequently, high activities of (131)I are required for effective thyroid volume reduction (TV), due to the low and heterogeneous radioactive iodine uptake (RAIU). Thiamazole (MTZ) may be used as an adjuvant to (131)I, by increasing RAIU. OBJECTIVE: To evaluate the effects of MTZ in the treatment of MNG with (131)I, in terms of TV reduction. DESIGN/METHODS: Nine female patients (aged 73.8 +/- 7.4 years) with MNG (eight with subclinical hyperthyroidism) were treated with MTZ. Doses started at 10 - 20 mg, and were adjusted monthly based on thyroid hormone levels. RAIU and TV were measured at baseline, and repeated when TSH levels > 6 mU/l were achieved. At that time, 1.11 GBq of (131)I were administered. RESULTS: Patients were treated with MTZ for 2.8 +/- 0.8 months. When a tracer activity of (131)I was administered, the mean serum TSH was elevated to 11.7 +/- 5.4 mU/l. MTZ led to significant increases in 24-h RAIU, from 21.3 +/- 8.1% to 78.3 +/- 15.3% (p < 0.001). One year after (131)I, median TV decreased from 97 ml (range 47 - 555 ml) to 56 ml (range 13 - 350 ml), a mean reduction of 46.2 +/- 17.8% (p = 0.012). Eight patients (89%) had subclinical hyperthyroidism, which was reversed in all patients after 1 year. Five patients (56%) developed overt hypothyroidism, and no clinical adverse events were observed. CONCLUSION: Pretreatment with MTZ targeting against an increased serum TSH did not impair the effects of (131)I. In our patients with MNG, MTZ increased RAIU and possibly enhanced (131)I efficacy, leading to significant TV reduction and reversion of hyperthyroidism in all patients.
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Both pretreatment with MMI allowing TSH to rise slightly and off-label use of rhTSH may reduce the total activity of RAI needed, but they increase the risk of hypothyroidism.
“Both pretreatment with MMI allowing the TSH to rise slightly (270) and the off-label use of rhTSH (271) may reduce the total activity of RAI needed, but they increase the risk of hypothyroidism (see prior discussion Section [K1]).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [270]
Pretreatment with MMI allowing TSH to rise slightly prior to RAI administration results in greater volume reduction after fixed doses of RAI.
“However, if volume reduction is a goal, at the expense of an increased risk of hypothyroidism, pretreatment with MMI, allowing the TSH to rise slightly prior to RAI administration, results in greater volume reduction after fixed doses of RAI (270).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [270]
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- Authors
- Albino, C. C., Graf, H., Sampaio, A. P., Vigário, A., & Paz-Filho, G. J.
- Affiliations
- Universidade Federal do Paraná (BR)
- Venue
- Expert Opinion on Investigational Drugs
- Publisher
- Informa Healthcare
- Published
- 2008-11-03
- Volume
- 17
- Issue
- 12
- Pages
- 1781-1786
- ISSN
- 1354-3784 (ISSN-L)
- 1744-7658
- OpenAlex
- W2096578805
- Cited by
- 24
- References
- 21
- Citations by year
- 2026: 1 · 2024: 4 · 2023: 1 · 2022: 2 · 2021: 1 · 2020: 1 · 2019: 2 · 2016: 2 · 2015: 2 · 2014: 1 · 2013: 1 · 2012: 3
- FWCI
- 0.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Expert Opinion on Investigational Drugs (publishedVersion)
- PubMed (publishedVersion)
- ANU Open Research (Australian National University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- multinodular goiter, methimazole, radioiodine therapy, iodine-131, thyroid volume reduction, radioiodine uptake, subclinical hyperthyroidism, overt hypothyroidism, TSH stimulation, older women, antithyroid drug withdrawal
- MeSH terms
- Aged, Female, Goiter, Nodular, Humans, Iodine Radioisotopes, Methimazole, Radiotherapy, Adjuvant
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