RADIOIODINE FOR NONTOXIC MULTINODULAR GOITER

Surgery is considered standard therapy for nontoxic goiter. However, s urgical treatment of large goiters is not without risk, especially in elderly patients and in those with cardiopulmonary diseases. Therefore , in recent years interest in I-131 treatment of nontoxic goiter has i ncreased. Studies, using ultrasonography and magnetic resonance imagin g (MRI) for accurate measurements of thyroid volume, have shown that I -131 treatment of nontoxic nodular goiter results in a mean thyroid vo lume reduction of 40% after 1 year and of 50-60% after 3-5 years. More over, an improvement of compressive symptoms can be achieved. This has been objectified by a significant decrease in tracheal compression as measured by MRI. Early side effects due to radiation thyroiditis usua lly are mild. The development of autoimmune hyperthyroidism occurring several months after I-131 therapy in approximately 5% of patients is the most important complication of I-131 therapy for nontoxic goiter. The incidence of post-treatment hypothyroidism appears to be similar t o 20-30% at 5 years. For elderly people, the lifetime risk of fatal an d nonfatal cancer induced by this therapy (administered activity 1.9 /- 0.9 GBq of I-131) was estimated to be approximately 0.5%. In all pa tients with nontoxic multinodular goiter the estimated risks of both s urgery and radioiodine therapy should be weighed carefully. In younger patients surgery still is to be preferred, especially when the amount of I-131 to be administered is high. However, for elderly patients, e specially those with cardiopulmonary disease, the profits of radioiodi ne treatment will outweigh the lifetime risk of this mode of therapy.