Prestimulation with Recombinant Human Thyrotropin (rhTSH) Improves the Long-Term Outcome of Radioiodine Therapy for Multinodular Nontoxic Goiter

Objective: The objective of the study was to evaluate the long-term outcome of recombinant human TSH (rhTSH)-augmented radioiodine (I-131) therapy for benign multinodular nontoxic goiter. Patients and Methods: Between 2002 and 2005, 86 patients with a multinodular nontoxic goiter were treated with I-131 in two randomized, double-blind, placebo-controlled trials. I-131-therapy was preceded by 0.3 mg rhTSH (n = 42) or placebo (n = 44). In 2009, 80 patients completed a follow-up (FU) visit, including determination of thyroid volume, thyroid function, and patient satisfaction by a visual analog scale. Results: In both groups, thyroid volume was further reduced from 1 yr to final FU (71 months). The mean goiter volume reductions obtained at 1 yr and final FU [59.2 +/- 2.4% (SEM) and 69.7 +/- 3.1%, respectively] in the rhTSH group were significantly greater than those obtained in the I-131-alone group (43.2 +/- 3.7 and 56.2 +/- 3.6%, respectively, P = 0.001 and P = 0.006), corresponding to a gain of 24% at final FU. At last FU the mean reduction in compression visual analog scale score was significantly greater in patients receiving rhTSH (P = 0.049). Additional therapy (thyroid surgery or I-131) was required more often in the placebo group (nine of 44) compared with the rhTSH group (two of 42) (P = 0.05). The prevalence of hypothyroidism at 1 yr [9 and 43% in the placebo and rhTSH groups, respectively (P < 0.0001)] increased to 16 and 52%, respectively, at final FU (P = 0.001). Conclusion: Enhanced goiter volume reduction with rhTSH-augmented I-131 therapy improves the long-term reduction in goiter-related symptoms and reduces the need for additional therapy compared with plain I-131 therapy. Overall patient satisfaction is benefited, despite a higher rate of permanent hypothyroidism. (J Clin Endocrinol Metab 97: 2653-2660, 2012)