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Laszlo Hegedus - One of the best experts on this subject based on the ideXlab platform.
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the role of radioiodine therapy in benign nodular Goitre
Best Practice & Research Clinical Endocrinology & Metabolism, 2014Co-Authors: Steen Joop Bonnema, Soren Fast, Laszlo HegedusAbstract:For treatment of benign nodular Goitre the choice usually stands between surgery and 131 I therapy. 131 I therapy, used for 30 years for this condition, leads to a Goitre volume reduction of 35–50% within 1–2 years. However, this treatment has limited efficacy if the thyroid 131 I uptake is low or if the Goitre is large. Recombinant human TSH (rhTSH)-stimulated 131 I therapy significantly improves Goitre reduction, as compared with conventional 131 I therapy without pre-stimulation, and adverse effects are few with rhTSH doses of 0.1 mg or lower. RhTSH-stimulated 131 I therapy reduces the need for additional therapy due to insufficient Goitre reduction, but the price is a higher rate of hypothyroidism. Another approach with rhTSH-stimulation is to reduce the administered 131 I activity by a factor that equals the increase in the thyroid 131 I uptake. Using this approach, radiation exposure is considerably reduced while the Goitre reduction is similar to that obtained with conventional 131 I therapy.
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time to reconsider nonsurgical therapy of benign non toxic multinodular Goitre focus on recombinant human tsh augmented radioiodine therapy
European Journal of Endocrinology, 2009Co-Authors: Soren Fast, Viveque Egsgaard Nielsen, Steen Joop Bonnema, Laszlo HegedusAbstract:The treatment of benign multinodular Goitre (MNG) is controversial, but surgery is recommended in large compressive Goitres. While some patients decline surgery others may have contraindications due to comorbidity, since MNG is prevalent in the elderly. Therefore, non-surgical treatment alternatives are needed. Until recently, levothyroxine therapy was the preferred non-surgical alternative, but due to low efficacy and potential side-effects, it is not recommended for routine use in recent international guidelines. Conventional radioiodine ( 131 I) therapy has been used for two decades as an effective and safe alternative to surgery in the treatment of symptomatic non-toxic MNG. Since much higher activities of 131 I are employed when treating non-toxic rather than toxic MNG, there has been reluctance in many countries to use this treatment modality. Frequently, the 131 I -uptake in a non-toxic MNG is low, which makes 131 I therapy less feasible. Another challenge is the negative correlation between the initial Goitre size and Goitre volume reduction (GVR). With its ability to more than double the thyroid 131 I-uptake, recombinant human TSH (rhTSH) increases the absorbed radiation dose and thus enhances the GVR by 35–56% at the expense of up to fivefold higher rate of permanent hypothyroidism. An alternative strategy is to reduce the administered 131 I-activity with a factor corresponding to the rhTSH induced increase in 131 I-uptake. Hereby, the extrathyroidal irradiation can be reduced without compromising efficacy. Thus, although in its infancy, and still experimental, rhTSH-augmented 131 I therapy may profoundly alter the non-surgical treatment of benign non-toxic MNG.
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the majority of danish nontoxic Goitre patients are ineligible for levothyroxine suppressive therapy
Clinical Endocrinology, 2008Co-Authors: Soren Fast, Steen Joop Bonnema, Laszlo HegedusAbstract:Summary Objective Levothyroxine suppressive therapy (LT4-therapy), aimed at shrinking thyroid nodules is controversial. Despite evidence of limited effect and long-term side-effects, questionnaire surveys indicate widespread use. Our aim was to determine, in consecutive nontoxic Goitre patients, the proportion ineligible for LT4-therapy. Exclusion criteria were set up in agreement with recent guidelines. Setting Secondary/tertiary referral centre at University Clinic. Subjects and methods During 1997–2001, 822 patients were referred to our endocrine unit on suspicion of nontoxic Goitre. Patients were evaluated clinically including fine needle aspiration biopsy, thyroid scintigraphy and ultrasound. Seven-hundred and forty-five patients (627 women and 118 men; median age 47 years, range 11–90) were potential candidates for LT4-therapy. Based on guidelines we defined conditions where LT4-therapy is contraindicated. Exclusion criteria included (1) Serum TSH < 1·0 mIU/l, (2) Post-menopausal status, or males older than 60 years, (3) Thyroid volume above 100 ml, (4) Intrathoracic Goitre, (5) Clinical suspicion of malignancy, (6) Dominant thyroid cyst, (7) Nondiagnostic FNA, (8) Previous ineffective LT4-therapy, (9) Elevated serum calcitonin, (10) Osteoporosis or cardiovascular disease. Results Of patients 84% were ineligible for LT4-therapy. In diffuse Goitre (n = 35) 63%, in uninodular Goitre (n = 320) 77% and in multinodular Goitre (n = 390) 91% were ineligible. Main ineligibility reasons were a low serum TSH, post-menopausal status, a large Goitre or clinical suspicion of malignancy. Conclusion The vast majority of consecutive Danish nontoxic Goitre patients (84%) were ineligible for LT4-therapy. Due to low efficacy and potential long-term adverse effects on the skeleton and cardiovascular system we strongly advocate against LT4-therapy for nontoxic Goitre.
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acute changes in thyroid volume and function following 131i therapy of multinodular Goitre
Clinical Endocrinology, 1994Co-Authors: Birte Nygaard, J Faber, Laszlo HegedusAbstract:Summary OBJECTIVE Many textbooks claim that radioIodine (131I) treatment should be given with care to a Goitre with substernal extension, for fear of acute swelling of the gland and thus respiratory problems. Since 131I Is used increasingly in the treatment of non-toxic as well as toxic Goitre we have evaluated the acute changes in thyroid volume following 131I therapy. DESIGN Evaluation of potential acute changes in thyroid volume and function after 131I treatment in patients with non-toxic Goitre treated because of compression symptoms or for cosmetic reasons, as well as In patients with toxic Goitre. PATIENTS Out-patients with multinodular Goitre, either non-toxic (n= 20) or toxic (n= 10). Excluded were patients with a substernal Goitre. MEASUREMENTS Ultrasonically determined thyroid volume and standard thyroid function variables were Investigated before and 2, 7, 14, 21, 28 and 35 days after treatment. RESULTS In non-toxic Goitres the thyroid volume did not increase significantly, the maximum increase in the median volume being 4% on day 7. Serum levels of free T3 and free T4 Indices increased by 20% (day 7) and 13% (day 14) (P= 0·002), respectively. Likewise thyroid volume in toxic nodular Goitre did not change significantly after 131I treatment (maximum median increase was 2%). None of the patients presented symptoms of tracheal compression. CONCLUSIONS 131I treatment of non-toxic as well as toxic multinodular Goitre does not seem to increase thyroid volume.
Soren Fast - One of the best experts on this subject based on the ideXlab platform.
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the role of radioiodine therapy in benign nodular Goitre
Best Practice & Research Clinical Endocrinology & Metabolism, 2014Co-Authors: Steen Joop Bonnema, Soren Fast, Laszlo HegedusAbstract:For treatment of benign nodular Goitre the choice usually stands between surgery and 131 I therapy. 131 I therapy, used for 30 years for this condition, leads to a Goitre volume reduction of 35–50% within 1–2 years. However, this treatment has limited efficacy if the thyroid 131 I uptake is low or if the Goitre is large. Recombinant human TSH (rhTSH)-stimulated 131 I therapy significantly improves Goitre reduction, as compared with conventional 131 I therapy without pre-stimulation, and adverse effects are few with rhTSH doses of 0.1 mg or lower. RhTSH-stimulated 131 I therapy reduces the need for additional therapy due to insufficient Goitre reduction, but the price is a higher rate of hypothyroidism. Another approach with rhTSH-stimulation is to reduce the administered 131 I activity by a factor that equals the increase in the thyroid 131 I uptake. Using this approach, radiation exposure is considerably reduced while the Goitre reduction is similar to that obtained with conventional 131 I therapy.
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time to reconsider nonsurgical therapy of benign non toxic multinodular Goitre focus on recombinant human tsh augmented radioiodine therapy
European Journal of Endocrinology, 2009Co-Authors: Soren Fast, Viveque Egsgaard Nielsen, Steen Joop Bonnema, Laszlo HegedusAbstract:The treatment of benign multinodular Goitre (MNG) is controversial, but surgery is recommended in large compressive Goitres. While some patients decline surgery others may have contraindications due to comorbidity, since MNG is prevalent in the elderly. Therefore, non-surgical treatment alternatives are needed. Until recently, levothyroxine therapy was the preferred non-surgical alternative, but due to low efficacy and potential side-effects, it is not recommended for routine use in recent international guidelines. Conventional radioiodine ( 131 I) therapy has been used for two decades as an effective and safe alternative to surgery in the treatment of symptomatic non-toxic MNG. Since much higher activities of 131 I are employed when treating non-toxic rather than toxic MNG, there has been reluctance in many countries to use this treatment modality. Frequently, the 131 I -uptake in a non-toxic MNG is low, which makes 131 I therapy less feasible. Another challenge is the negative correlation between the initial Goitre size and Goitre volume reduction (GVR). With its ability to more than double the thyroid 131 I-uptake, recombinant human TSH (rhTSH) increases the absorbed radiation dose and thus enhances the GVR by 35–56% at the expense of up to fivefold higher rate of permanent hypothyroidism. An alternative strategy is to reduce the administered 131 I-activity with a factor corresponding to the rhTSH induced increase in 131 I-uptake. Hereby, the extrathyroidal irradiation can be reduced without compromising efficacy. Thus, although in its infancy, and still experimental, rhTSH-augmented 131 I therapy may profoundly alter the non-surgical treatment of benign non-toxic MNG.
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the majority of danish nontoxic Goitre patients are ineligible for levothyroxine suppressive therapy
Clinical Endocrinology, 2008Co-Authors: Soren Fast, Steen Joop Bonnema, Laszlo HegedusAbstract:Summary Objective Levothyroxine suppressive therapy (LT4-therapy), aimed at shrinking thyroid nodules is controversial. Despite evidence of limited effect and long-term side-effects, questionnaire surveys indicate widespread use. Our aim was to determine, in consecutive nontoxic Goitre patients, the proportion ineligible for LT4-therapy. Exclusion criteria were set up in agreement with recent guidelines. Setting Secondary/tertiary referral centre at University Clinic. Subjects and methods During 1997–2001, 822 patients were referred to our endocrine unit on suspicion of nontoxic Goitre. Patients were evaluated clinically including fine needle aspiration biopsy, thyroid scintigraphy and ultrasound. Seven-hundred and forty-five patients (627 women and 118 men; median age 47 years, range 11–90) were potential candidates for LT4-therapy. Based on guidelines we defined conditions where LT4-therapy is contraindicated. Exclusion criteria included (1) Serum TSH < 1·0 mIU/l, (2) Post-menopausal status, or males older than 60 years, (3) Thyroid volume above 100 ml, (4) Intrathoracic Goitre, (5) Clinical suspicion of malignancy, (6) Dominant thyroid cyst, (7) Nondiagnostic FNA, (8) Previous ineffective LT4-therapy, (9) Elevated serum calcitonin, (10) Osteoporosis or cardiovascular disease. Results Of patients 84% were ineligible for LT4-therapy. In diffuse Goitre (n = 35) 63%, in uninodular Goitre (n = 320) 77% and in multinodular Goitre (n = 390) 91% were ineligible. Main ineligibility reasons were a low serum TSH, post-menopausal status, a large Goitre or clinical suspicion of malignancy. Conclusion The vast majority of consecutive Danish nontoxic Goitre patients (84%) were ineligible for LT4-therapy. Due to low efficacy and potential long-term adverse effects on the skeleton and cardiovascular system we strongly advocate against LT4-therapy for nontoxic Goitre.
Steen Joop Bonnema - One of the best experts on this subject based on the ideXlab platform.
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the role of radioiodine therapy in benign nodular Goitre
Best Practice & Research Clinical Endocrinology & Metabolism, 2014Co-Authors: Steen Joop Bonnema, Soren Fast, Laszlo HegedusAbstract:For treatment of benign nodular Goitre the choice usually stands between surgery and 131 I therapy. 131 I therapy, used for 30 years for this condition, leads to a Goitre volume reduction of 35–50% within 1–2 years. However, this treatment has limited efficacy if the thyroid 131 I uptake is low or if the Goitre is large. Recombinant human TSH (rhTSH)-stimulated 131 I therapy significantly improves Goitre reduction, as compared with conventional 131 I therapy without pre-stimulation, and adverse effects are few with rhTSH doses of 0.1 mg or lower. RhTSH-stimulated 131 I therapy reduces the need for additional therapy due to insufficient Goitre reduction, but the price is a higher rate of hypothyroidism. Another approach with rhTSH-stimulation is to reduce the administered 131 I activity by a factor that equals the increase in the thyroid 131 I uptake. Using this approach, radiation exposure is considerably reduced while the Goitre reduction is similar to that obtained with conventional 131 I therapy.
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time to reconsider nonsurgical therapy of benign non toxic multinodular Goitre focus on recombinant human tsh augmented radioiodine therapy
European Journal of Endocrinology, 2009Co-Authors: Soren Fast, Viveque Egsgaard Nielsen, Steen Joop Bonnema, Laszlo HegedusAbstract:The treatment of benign multinodular Goitre (MNG) is controversial, but surgery is recommended in large compressive Goitres. While some patients decline surgery others may have contraindications due to comorbidity, since MNG is prevalent in the elderly. Therefore, non-surgical treatment alternatives are needed. Until recently, levothyroxine therapy was the preferred non-surgical alternative, but due to low efficacy and potential side-effects, it is not recommended for routine use in recent international guidelines. Conventional radioiodine ( 131 I) therapy has been used for two decades as an effective and safe alternative to surgery in the treatment of symptomatic non-toxic MNG. Since much higher activities of 131 I are employed when treating non-toxic rather than toxic MNG, there has been reluctance in many countries to use this treatment modality. Frequently, the 131 I -uptake in a non-toxic MNG is low, which makes 131 I therapy less feasible. Another challenge is the negative correlation between the initial Goitre size and Goitre volume reduction (GVR). With its ability to more than double the thyroid 131 I-uptake, recombinant human TSH (rhTSH) increases the absorbed radiation dose and thus enhances the GVR by 35–56% at the expense of up to fivefold higher rate of permanent hypothyroidism. An alternative strategy is to reduce the administered 131 I-activity with a factor corresponding to the rhTSH induced increase in 131 I-uptake. Hereby, the extrathyroidal irradiation can be reduced without compromising efficacy. Thus, although in its infancy, and still experimental, rhTSH-augmented 131 I therapy may profoundly alter the non-surgical treatment of benign non-toxic MNG.
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the majority of danish nontoxic Goitre patients are ineligible for levothyroxine suppressive therapy
Clinical Endocrinology, 2008Co-Authors: Soren Fast, Steen Joop Bonnema, Laszlo HegedusAbstract:Summary Objective Levothyroxine suppressive therapy (LT4-therapy), aimed at shrinking thyroid nodules is controversial. Despite evidence of limited effect and long-term side-effects, questionnaire surveys indicate widespread use. Our aim was to determine, in consecutive nontoxic Goitre patients, the proportion ineligible for LT4-therapy. Exclusion criteria were set up in agreement with recent guidelines. Setting Secondary/tertiary referral centre at University Clinic. Subjects and methods During 1997–2001, 822 patients were referred to our endocrine unit on suspicion of nontoxic Goitre. Patients were evaluated clinically including fine needle aspiration biopsy, thyroid scintigraphy and ultrasound. Seven-hundred and forty-five patients (627 women and 118 men; median age 47 years, range 11–90) were potential candidates for LT4-therapy. Based on guidelines we defined conditions where LT4-therapy is contraindicated. Exclusion criteria included (1) Serum TSH < 1·0 mIU/l, (2) Post-menopausal status, or males older than 60 years, (3) Thyroid volume above 100 ml, (4) Intrathoracic Goitre, (5) Clinical suspicion of malignancy, (6) Dominant thyroid cyst, (7) Nondiagnostic FNA, (8) Previous ineffective LT4-therapy, (9) Elevated serum calcitonin, (10) Osteoporosis or cardiovascular disease. Results Of patients 84% were ineligible for LT4-therapy. In diffuse Goitre (n = 35) 63%, in uninodular Goitre (n = 320) 77% and in multinodular Goitre (n = 390) 91% were ineligible. Main ineligibility reasons were a low serum TSH, post-menopausal status, a large Goitre or clinical suspicion of malignancy. Conclusion The vast majority of consecutive Danish nontoxic Goitre patients (84%) were ineligible for LT4-therapy. Due to low efficacy and potential long-term adverse effects on the skeleton and cardiovascular system we strongly advocate against LT4-therapy for nontoxic Goitre.
Nicola Avenia - One of the best experts on this subject based on the ideXlab platform.
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total or near total thyroidectomy versus subtotal thyroidectomy for multinodular non toxic Goitre in adults
Cochrane Database of Systematic Reviews, 2015Co-Authors: Roberto Cirocchi, Alberto Arezzo, Stefano Trastulli, Justus Randolph, Salvatore Guarino, Giorgio Di Rocco, Vito Dandrea, A Santoro, Marcin Barczynski, Nicola AveniaAbstract:Background Total thyroidectomy (TT) and subtotal thyroidectomy (ST) are worldwide treatment options for multinodular non-toxic Goitre in adults. Near TT, defined as a postoperative thyroid remnant less than 1 mL, is supposed to be a similarly effective but safer option than TT. ST has been shown to be marginally safer than TT, but it may leave an undetected thyroid cancer in place. Objectives The objective was to assess the effects of total or near-total thyroidectomy compared to subtotal thyroidectomy for multinodular non-toxic Goitre. Search methods We searched the Cochrane Library, MEDLINE, PubMed, EMBASE, as well as the ICTRP Search Portal and ClinicalTrials.gov. The date of the last search was 18 June 2015 for all databases. No language restrictions were applied. Selection criteria Two review authors independently scanned the abstract, title or both sections of every record retrieved to identify randomised controlled trials (RCTs) on thyroidectomy for multinodular non-toxic Goitre for further assessment. Data collection and analysis Two review authors independently extracted data, assessed studies for risk of bias and evaluated overall study quality utilising the GRADE instrument. We calculated the odds ratio (OR) and corresponding 95% confidence interval (CI) for dichotomous outcomes. A random-effects model was used for pooling data. Main results We examined 1430 records, scrutinized 14 full-text publications and included four RCTs. Altogether 1305 participants entered the four trials, 543 participants were randomised to TT and 762 participants to ST. A total of 98% and 97% of participants finished the trials in the TT and ST groups, respectively. Two trials had a duration of follow-up between 12 and 39 months and two trials a follow-up of 5 and 10 years, respectively. Risk of bias across studies was mainly unknown for selection, performance and detection bias. Attrition bias was generally low and reporting bias high for some outcomes. In the short-term postoperative period no deaths were reported for both TT and ST groups. However, longer-term data on all-cause mortality were not reported (1284 participants; 4 trials; moderate quality evidence). Goiter recurrence was lower in the TT group compared to ST. Goiters recurred in 0.2% (1/425) of the TT group compared to 8.4% (53/632) of the ST group (OR 0.05 (95% CI 0.01 to 0.21); P < 0.0001; 1057 participants; 3 trials; moderate quality evidence). Re-intervention due to Goitre recurrence was lower in the TT group compared to ST. Re-intervention was necessary in 0.5% (1/191) of TT patients compared to 0.8% (3/379)of ST patients (OR 0.66 (95% CI 0.07 to 6.38); P = 0.72; 570 participants; 1 trial; low quality evidence). The incidence of permanent recurrent laryngeal nerve palsy was lower for ST compared with TT. Permanent recurrent laryngeal nerve palsy occurred in 0.8% (6/741) of ST patients compared to 0.7% (4/543) of TT patients (OR 1.28, (95% CI 0.38 to 4.36); P = 0.69; 1275 participants; 4 trials; low quality evidence). The incidence of permanent hypoparathyroidism was lower for ST compared with TT. Permanent hypoparathyroidism occurred in 0.1% (1/741) of ST patients compared to 0.6% (3/543) of TT patients (OR 3.09 (95% CI 0.45 to 21.36); P = 0.25; 1275 participants: 4 trials; low quality evidence). The incidence of thyroid cancer was lower for ST compared with TT. Thyroid cancer occurred in 6.1% (41/669) of ST patients compared to 7.3% (34/465)of TT patients (OR 1.32 (95% CI 0.81 to 2.15); P = 0.27; 1134 participants; 3 trials; low quality evidence). No data on health-related quality of life or socioeconomic effects were reported in the included studies. Authors' conclusions The body of evidence on TT compared with ST is limited. Goiter recurrence is reduced following TT. The effects on other key outcomes such as re-interventions due to Goitre recurrence, adverse events and thyroid cancer incidence are uncertain. New long-term RCTs with additional data such as surgeons level of experience, treatment volume of surgical centres and details on techniques used are needed.
Wilmar M. Wiersinga - One of the best experts on this subject based on the ideXlab platform.
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Management of nontoxic multinodular Goitre
Oxford Textbook of Endocrinology and Diabetes, 2020Co-Authors: Wilmar M. WiersingaAbstract:Goitres can be classified according to thyroid function into toxic Goitres, hypothyroid Goitres, and euthyroid or nontoxic Goitres (see Chapter 3.5.1). The most prevalent causes of nontoxic Goitre are endemic (iodine-deficient) Goitre and sporadic nontoxic Goitre (diffuse or nodular). The disease entity of sporadic nontoxic Goitre is defined as a benign enlargement of the thyroid gland of unknown cause, in euthyroid patients (normal serum free thyroxine (T4) and free triiodothyronine (T3) concentrations) living in an area without endemic Goitre. The diagnosis is by exclusion. The prevalence of sporadic nontoxic Goitre (also called simple Goitre) in the adult population is high, 3.2% in the UK (see Chapter 3.1.7), and it is more common in women (5.3%) than in men (0.8%). This chapter deals predominantly with sporadic nontoxic multinodular Goitre.
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determinants of longterm outcome of radioiodine therapy of sporadic non toxic Goitre
Clinical Endocrinology, 1999Co-Authors: Le R Moli, Maria F T Wesche, M Tielvan M C Buul, Wilmar M. WiersingaAbstract:Summary OBJECTIVE Radioiodine treatment is effective inreducing the size of sporadic nontoxic Goitre, albeitat the expense of a high incidence of postradiationhypothyroidism. The decreasein Goitre size, however,is not observed in all subjects, and little is knownabout recurrent Goitre growth after 131 I therapy. Theaim of the presentstudy was to evaluatewhich factorsdetermine the longterm outcome of 131 I treatment inpatients with sporadic nontoxic nodular Goitre, interms of changes in both thyroid size and thyroidfunction. STUDY DESIGN Retrospective follow-up study. PATIENTS Fifty patients with sporadic nontoxic nod-ular Goitre wereevaluatedwho had beentreatedin ourinstitution with 131 I (mean dose 4·4 MBq/g thyroid) inthe period 1988–95. Nine patients received a seconddoseof 131 I andoneathird. Median follow-up timewas41 months (range 24–115). MEASUREMENTS Thyroid function was assesed byTSH and FT4 index, and thyroid volume by ultrasoundin 46 patients, by scintiscan using the Himanka for-mula in three and by CT-scan in one. The response totreatment was defined as a decrease in thyroidvolume of greater than 13% (i.e. the mean þ2SD ofthe coefficient of variation of volume measurements),and recurrent Goitre as an increase in thyroid volumegreater than 13% after an initial response.