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Compressive Non-Toxic Intrathoracic Goiter in Patient with Contraindication to Surgical Treatment: Case Report

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Open Access
Article Type Case Report
Subject Medicine Group
OCLC 9501834982
Gustavo Cancela E Penna*, Rachel Cardoso Lopes Rego, Gabriela Malta Silva Diniz, Gabriela Maciel Campolina Cardoso, Rudolf Moreira Pfeilsticker, Adelina Sanches, Barbara Moreira Ribeiro Trindade dos Santos and Hans Graf
Issue: Volume3-Issue3
Pages: 240-245
Received: 2022-03-06
Accepted: 2022-03-08
Published: 2022-03-11

Abstract

Introduction: Thyroidectomy is the treatment of choice for non-toxic compressive Multinodular Goiter (MNG). However, when surgery is contraindicated, other therapeutic options should be evaluated. In this case report, non-surgical therapeutic possibilities are reviewed, and the results obtained with Radioiodine Therapy (RAI) after stimulating with Recombinant Thyroid-Stimulating Hormone (rhTSH) are described.

Case report: A 92-year-old patient with multiple comorbidities, non-toxic MNG, and symptomatic compression of the trachea and esophagus. Accordingly, RAI was chosen due to the high surgical risk. Initially, pre-treatment with methimazole was performed to increase TSH, which was interrupted due to drug hepatitis. Then, RAI was chosen in the post-stimulus with a low dose of rhTSH, with significant and early reduction of goiter and symptoms.

Discussion: Although total thyroidectomy is the treatment of choice for non-toxic and symptomatic intrathoracic MNG; it does present risks, especially in patients with multiple comorbidities. Thus, interest in less invasive techniques is increasing. Thermal radio-ablations exhibit satisfactory results, however it is still an inaccessible technique. Radioiodine is an effective treatment option subsequent to the use of rhTSH or hypothyroidism methimazole-induced. RhTSH and methimazole can increase the level of radiation absorbed by the gland, which can lead to a reduction in the required I-131 dose.

Conclusion: It is possible to mitigate the symptoms and improve the quality of life of patients with non-toxic and symptomatic MNG and multiple comorbidities, without surgical intervention. In this case report we describe alternatives to surgical intervention and show the effectiveness and safety of RAI along with rhTSH in the management of MNG.

FullText HTML FullText PDF DOI: 10.37871/jbres1429 Crossmark

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© 2022 Gustavo Cancela EP, et al. Distributed under Creative Commons CC-BY 4.0 Creative CommonsAttribution

How to cite this article

Gustavo Cancela EP, Lopes Rego RC, Silva Diniz GM, Campolina Cardoso GM, Pfeilsticker RM, Sanches A, Trindade dos Santos BMR, Graf H. Compressive Non-Toxic Intrathoracic Goiter in Patient with Contraindication to Surgical Treatment: Case Report. J Biomed Res Environ Sci. 2022 Mar 11; 3(3): 240-245. doi: 10.37871/jbres1429, Article ID: JBRES1429, Available at: https://www.jelsciences.com/articles/jbres1429.pdf

Subject area(s)

Public HealthClinical EndocrinologySurgery

References

  1. Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab. 2008 Dec;22(6):901-11. doi: 10.1016/j.beem.2008.09.019. PMID: 19041821.
  2. Durante C, Grani G, Lamartina L, Filetti S, Mandel SJ, Cooper DS. The Diagnosis and Management of Thyroid Nodules: A Review. JAMA. 2018 Mar 6;319(9):914-924. doi: 10.1001/jama.2018.0898. Erratum in: JAMA. 2018 Apr 17;319(15):1622. PMID: 29509871.
  3. Hegedüs L, Bonnema SJ, Bennedbaek FN. Management of simple nodular goiter: current status and future perspectives. Endocr Rev. 2003 Feb;24(1):102-32. doi: 10.1210/er.2002-0016. PMID: 12588812.
  4. Albino CC, Graf H, Sampaio AP, Vigário A, Paz-Filho GJ. Thiamazole as an adjuvant to radioiodine for volume reduction of multinodular goiter. Expert Opin Investig Drugs. 2008 Dec;17(12):1781-6. doi: 10.1517/13543780802501325. PMID: 19012495.
  5. Fast S, Nielsen VE, Bonnema SJ, Hegedüs L. Time to reconsider nonsurgical therapy of benign non-toxic multinodular goitre: focus on recombinant human TSH augmented radioiodine therapy. Eur J Endocrinol. 2009 Apr;160(4):517-28. doi: 10.1530/EJE-08-0779. Epub 2008 Dec 23. PMID: 19106244.
  6. Nielsen VE, Bonnema SJ, Hegedüs L. Transient goiter enlargement after administration of 0.3 mg of recombinant human thyrotropin in patients with benign nontoxic nodular goiter: a randomized, double-blind, crossover trial. J Clin Endocrinol Metab. 2006 Apr;91(4):1317-22. doi: 10.1210/jc.2005-2137. Epub 2006 Jan 24. PMID: 16434453.
  7. Baek JH, Kim YS, Sung JY, Choi H, Lee JH. Locoregional control of metastatic well-differentiated thyroid cancer by ultrasound-guided radiofrequency ablation. AJR Am J Roentgenol. 2011 Aug;197(2):W331-6. doi: 10.2214/AJR.10.5345. PMID: 21785061.
  8. Monchik JM, Donatini G, Iannuccilli J, Dupuy DE. Radiofrequency ablation and percutaneous ethanol injection treatment for recurrent local and distant well-differentiated thyroid carcinoma. Ann Surg. 2006 Aug;244(2):296-304. doi: 10.1097/01.sla.0000217685.85467.2d. PMID: 16858194; PMCID: PMC1602167.
  9. Na DG, Lee JH, Jung SL, Kim JH, Sung JY, Shin JH, Kim EK, Lee JH, Kim DW, Park JS, Kim KS, Baek SM, Lee Y, Chong S, Sim JS, Huh JY, Bae JI, Kim KT, Han SY, Bae MY, Kim YS, Baek JH; Korean Society of Thyroid Radiology (KSThR); Korean Society of Radiology. Radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: consensus statement and recommendations. Korean J Radiol. 2012 Mar-Apr;13(2):117-25. doi: 10.3348/kjr.2012.13.2.117. Epub 2012 Mar 7. PMID: 22438678; PMCID: PMC3303894.
  10. Ugurlu MU, Uprak K, Akpinar IN, Attaallah W, Yegen C, Gulluoglu BM. Radiofrequency ablation of benign symptomatic thyroid nodules: prospective safety and efficacy study. World J Surg. 2015 Apr;39(4):961-8. doi: 10.1007/s00268-014-2896-1. PMID: 25446486.
  11. Jeong WK, Baek JH, Rhim H, Kim YS, Kwak MS, Jeong HJ, Lee D. Radiofrequency ablation of benign thyroid nodules: safety and imaging follow-up in 236 patients. Eur Radiol. 2008 Jun;18(6):1244-50. doi: 10.1007/s00330-008-0880-6. Epub 2008 Feb 20. PMID: 18286289.
  12. Baek JH, Lee JH, Valcavi R, Pacella CM, Rhim H, Na DG. Thermal ablation for benign thyroid nodules: radiofrequency and laser. Korean J Radiol. 2011 Sep-Oct;12(5):525-40. doi: 10.3348/kjr.2011.12.5.525. Epub 2011 Aug 24. PMID: 21927553; PMCID: PMC3168793.
  13. Lang BH, Woo YC, Wong CKH. High-Intensity Focused Ultrasound for Treatment of Symptomatic Benign Thyroid Nodules: A Prospective Study. Radiology. 2017 Sep;284(3):897-906. doi: 10.1148/radiol.2017161640. Epub 2017 Apr 18. PMID: 28419814.
  14. Le Moli R, Wesche MF, Tiel-Van Buul MM, Wiersinga WM. Determinants of longterm outcome of radioiodine therapy of sporadic non-toxic goitre. Clin Endocrinol (Oxf). 1999 Jun;50(6):783-9. doi: 10.1046/j.1365-2265.1999.00734.x. PMID: 10468951.
  15. Szumowski P, Abdelrazek S, Sykała M, Mojsak M, Żukowski Ł, Siewko K, Maliszewska K, Adamska A, Popławska-Kita A, Krętowski A, Myśliwiec J. Enhancing the efficacy of 131I therapy in non-toxic multinodular goitre with appropriate use of methimazole: an analysis of randomized controlled study. Endocrine. 2020 Jan;67(1):136-142. doi: 10.1007/s12020-019-02100-x. Epub 2019 Oct 4. PMID: 31586293; PMCID: PMC6969001.
  16. Giusti M, Caorsi V, Mortara L, Caputo M, Monti E, Schiavo M, Bagnara MC, Minuto F, Bagnasco M. Long-term outcome after radioiodine therapy with adjuvant rhTSH treatment: comparison between patients with non-toxic and pre-toxic large multinodular goitre. Endocrine. 2014 Mar;45(2):221-9. doi: 10.1007/s12020-013-9959-1. Epub 2013 Apr 26. PMID: 23619962.
  17. Fast S, Nielsen VE, Grupe P, Boel-Jørgensen H, Bastholt L, Andersen PB, Bonnema SJ, Hegedüs L. Prestimulation with recombinant human thyrotropin (rhTSH) improves the long-term outcome of radioiodine therapy for multinodular nontoxic goiter. J Clin Endocrinol Metab. 2012 Aug;97(8):2653-60. doi: 10.1210/jc.2011-3335. Epub 2012 May 10. PMID: 22577172.
  18. Cubas ER, Paz-Filho GJ, Olandoski M, Goedert CA, Woellner LC, Carvalho GA, Graf H. Recombinant human TSH increases the efficacy of a fixed activity of radioiodine for treatment of multinodular goitre. Int J Clin Pract. 2009 Apr;63(4):583-90. doi: 10.1111/j.1742-1241.2008.01904.x. Epub 2008 Sep 18. PMID: 18803554.
  19. Lee YY, Tam KW, Lin YM, Leu WJ, Chang JC, Hsiao CL, Hsu MT, Hsieh AT. Recombinant human thyrotropin before (131)I therapy in patients with nodular goitre: a meta-analysis of randomized controlled trials. Clin Endocrinol (Oxf). 2015 Nov;83(5):702-10. doi: 10.1111/cen.12654. Epub 2014 Dec 29. PMID: 25370124.
  20. Romão R, Rubio IG, Tomimori EK, Camargo RY, Knobel M, Medeiros-Neto G. High prevalence of side effects after recombinant human thyrotropin-stimulated radioiodine treatment with 30 mCi in patients with multinodular goiter and subclinical/clinical hyperthyroidism. Thyroid. 2009 Sep;19(9):945-51. doi: 10.1089/thy.2008.0394. PMID: 19678745.
  21. Bonnema SJ, Bertelsen H, Mortensen J, Andersen PB, Knudsen DU, Bastholt L, Hegedüs L. 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. J Clin Endocrinol Metab. 1999 Oct;84(10):3636-41. doi: 10.1210/jcem.84.10.6052. PMID: 10523007.
  22. Nielsen VE, Bonnema SJ, Hegedüs L. Effects of 0.9 mg recombinant human thyrotropin on thyroid size and function in normal subjects: a randomized, double-blind, cross-over trial. J Clin Endocrinol Metab. 2004 May;89(5):2242-7. doi: 10.1210/jc.2003-031783. PMID: 15126548.
  23. Albino CC, Graf H, Paz-Filho G, Diehl LA, Olandoski M, Sabbag A, Buchpiguel C. Radioiodine plus recombinant human thyrotropin do not cause acute airway compression and are effective in reducing multinodular goiter. Braz J Med Biol Res. 2010 Mar;43(3):303-9. doi: 10.1590/s0100-879x2010007500001. PMID: 20401438.
  24. Bonnema SJ, Hegedüs L. A 30-year perspective on radioiodine therapy of benign nontoxic multinodular goiter. Curr Opin Endocrinol Diabetes Obes. 2009 Oct;16(5):379-84. doi: 10.1097/MED.0b013e32832ff2e1. PMID: 19623060.
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