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| |  Radioiodine Treatment Effective for Patients With Nontoxic Multinodular Goiter: Presented at ECE By Chris Berrie BERLIN -- May 7, 2008 -- Radioiodine treatment is efficacious for patients with nontoxic multinodular goiter, with the greatest reduction in tumour volume and appearance of hypothyroidism occurring within 2 years of follow-up, researchers reported here at the 10th European Congress of Endocrinology (ECE). However, the addition of lithium has no effect on radioiodine treatment, autoimmunity, or development of hypothyroidism, said principal investigator Guia Vannucchi, MD, PhD, Endocrinologist, Department of Medical Sciences, Fondazione Ospedale Maggiore IRCCS, Milan, Italy. As Dr. Vannucchi indicated here on May 5, earlier research showed that for patients with Graves' disease, lithium therapy enhances radioiodine efficacy and reduces transient radioiodine-induced thyrotoxicosis. "We wanted to study the efficacy of radioiodine therapy in these patients with or without the association of lithium therapy," Dr. Vannucchi said. Eighty patients with nontoxic multinodular goiter (age range, 34-84 years; male, 16%) were randomised to either radioiodine treatment alone or in combination with lithium 900 mg/day for 6 days started on the day of radioiodine treatment. Radioiodine activity was calculated according to patient thyroid volume, with a mean dose per patient of 555 megabecquerel (MBq) (range, 222-600 MBq). Patients were evaluated with ultrasound and biochemical analyses at baseline, at 1 week and at 1, 3, 6, and 12 months. Long-term follow-up was conducted at 41 to 70 months, with 23 patients (radioiodine alone) and 22 patients (radioiodine/lithium) remaining in each group. Mean reduction in tumour volume was 49.5% without or with lithium treatment. During this time, thyroid-stimulating hormone levels significantly improved (P < .004) to similar extents across the 2 treatment groups. In the long-term follow-up, with 3 patients undergoing total thyroidectomy, there was a further mean reduction of 50.7% in tumour volume in 61% of patients, with no significant difference between treatment groups. Of note, the hypothyroidism seen in 14 patients developed in the first 2 years of treatment. Thus, these data confirm the efficacy of radioiodine treatment in patients with nontoxic multinodular goiter and demonstrate that maximum thyroid volume reduction occurs within the first 2 years of treatment, with no relapses seen in long-term follow-up. Furthermore, addition of lithium does not affect either the efficacy of radioiodine therapy or the development of permanent hypothyroidism. However, regarding lithium use, Dr. Vannucchi noted, "In our previous study we demonstrated that there was no difference between the 2 groups in terms of efficacy, but there was a difference in radioiodine-induced thyrotoxicosis, so lithium is protective with respect to radioiodine-induced thyrotoxicosis, but not radioiodine efficacy." [Presentation title: Radioiodine Treatment in Non-Toxic Multinodular Goiter: A Large Series Prospectively Studied at 5 Years Follow-Up. Abstract P765]
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