Radioiodine Therapy After Pretreatment With Recombinant Thyroid-stimulating Hormone (tsh) in Toxic Multinodular Goiter With Low Radioactive Iodine Uptake

Abstract: Managing toxic multinodular goiter in elderly patients can be challenging as age, presence of chronic disease, polypharmacy, and poor medication compliance can limit the use of surgery and long-term antithyroid drugs. Treatment with 131I may not produce the best outcome in states of low radioiodine uptake. Recombinant human thyroid-stimulating hormone (rh-TSH, Thyrogen) used as pretreatment for radioiodine therapy, however, can be useful in this clinical scenario. We report a patient successfully treated (a 94-year-old man on polypharmacy for multiple medical conditions) with radioiodine after pretreatment with rh-TSH. The radioiodine uptake increased with rh-TSH administration and allowed successful treatment with 15.4 mCu of 131I. Recovery from hyperthyroidism was associated with a 71% reduction in the size of thyroid gland by sonography.