Treatment of toxic multinodular goiter (hummer's disease): Surgery or radioiodine?

Abstract

The records of patients treated at the Mayo Clinic for toxic multinodular goiter during 1950–1954, 1960–1964, and 1970–1974 were reviewed to compare results of surgical and131I therapy, to define trends in treatment policy and outcome, and to attempt to elucidate factors associated with posttreatment hypothyroidism. The series involved 446 patients who underwent thyroidectomy as initial treatment and 89 who initially received131I. The time to success was significantly shorter (p=0.001) in surgically treated patients than in patients initially receiving131I. Compared with patients treated medically, patients treated initially with surgery were much less likely to require a second treatment (0% versus 24%) during the first year after initial treatment. The probability of postthyroidectomy hypothyroidism increased from approximately 12% in the 1950s to more than 70% in the 1970s at 2 years after surgery. Neither more aggressive surgery nor use of more sensitive tests to diagnose hypothyroidism accounted for the increased probability in recent years.

Results of Surgery for Toxic Multinodular Goiter

“…3,4 Most studies have shown that hyperthyroidism produces the highest rate of complications, in the form of hypoparathyroidism (3.8%-14%) or recurrent lesions (4%-13%), [5][6][7] Moreover, it usually occurs in older patients, who often have high surgical risk, which is why alternative nonsurgical therapy is being sought. 8,9 Thus, treatment through ablation with radioiodine has been assessed in various studies, often achieving euthyroidism, although the incidence of relapse of hyperthyroidism is high (6%-64%) and radioiodine is not risk free, being associated with thyroid dysfunction and cancer, [10][11][12][13][14] Our objective was to analyze the clinical and histological features of patients treated surgically for TMG to establish a clinical profile and evaluate postoperative morbidity and mortality, remission of symptoms, and relapse of the goiter.…”

Long-term results of two schedules of radioiodine treatment for toxic multinodular goitre

“…In earlier reports on the results of this treatment, different Later studies on radioiodine therapy of Graves' disease showed that regardless of the dosage schedule used, patients with Graves' disease are at high risk of becoming hypothyroid [1,2]. In studies on the results of radioiodine treatment of patients with toxic uni-and multinodular goitres, incidences of hypothyroidism are extremely varied, ranging from 1% to 64% [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. However, interpretation of literature data is difficult for several reasons.…”

Surgical Management of Toxic Multinodular Goiter

“…[9][10][11][12][13][14][15][16][17] Surgery provides immediate treatment of thyrotoxicosis whereas RAI therapy takes longer. In our series, rapid control of thyrotoxicosis was achieved in all cases, and 125 patients (89%) were classified as stable euthyroid within 3 months.…”