The Feasibility of High Dose Iodine 131 Treatment as an Alternative to Surgery in Patients with a Very Large Goiter: Effect on Thyroid Function and Size and Pulmonary Function

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Abstract
Some patients with very large goiters (.150 mL) are not candi- dates for surgery. We evaluated the feasibility of high dose 131I in such patients. Twenty-three patients (2 men and 21 women; median age, 67 yr; range, 42- 86 yr) with very large goiter (8 toxic) were treated with calculated high dose 131I (median, 2281 megabecquerels (61.6 mCi); range, 988-4620 megabecquerels (26.7-124.9 mCi)). During the 12-month observation period, goiter reduction and tracheal anatomy were monitored by magnetic resonance imaging, and the respiratory capacity was monitored by pulmonary function tests. Five patients (22%) developed hypothyroidism. Thyroid volumes were at baseline, after 1 week, and after 1 yr (mean 6 SEM, 311 6 28, 314 6 26 (P 5 NS), and 215 6 26 (P , 0.01) mL). The relative changes 1 week after therapy ranged from 214.1% to 15.3%. After 1 yr the mean size was reduced by 33.9% (range, 13.5- 61.4%). Only the initial goiter size showed a significant negative correlation to the percent reduction. The smallest cross-sectional area of the trachea decreased 9.2% within 1 week after treatment, but eventually emerged with a 17.9% larger area (mean 6 SEM, 84.3 6 4.8, 75.5 6 5.1 (P , 0.01), and 98.2 6 6.0 (P , 0.01) mm2). The inspiratory parameter, FIF50%, improved after an initial insignificant decline (baseline therapy, after 1 week, after 3 months, and after 1 yr (mean 6 SEM), 2.37 6 0.24, 2.20 6 0.21 (P 5 NS), 2.51 6 0.23 (P 5 NS), and 2.76 6 0.25 (P 5 0.01) L/s). FIF50% correlated significantly with the smallest cross-sectional tracheal area (baseline, 1 week, and 1 yr: r 5 0.74; P , 0.001, r 5 0.63; P , 0.005, and r 5 0.46; P , 0.05). Changes in tracheal anatomy did not correlate with changes in either lung dynamics or goiter size. In conclusion, very large goiters can be reduced by a third, on the av- erage, with high dose 131I therapy without any initial clinically sig- nificant tracheal compression. Tracheal cross-sectional area as well as pulmonary inspiratory capacity improve. No serious adverse ef- fects are seen. (J Clin Endocrinol Metab 84: 3636 -3641, 1999)

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