Recombinant human thyrotropin stimulated 131 I treatment for multinodular goiter.

The aim of the study was to investigate the effects of rhTSH stimulation before 131 I treatment in patients with MNG.

METHODS: Sources included the Cochrane Library, MEDLINE, EMBASE, and SCOPUS database (all until January 2016). Randomized controlled trials (RCTs) that assessed the efficacy of rhTSH-stimulated 131 I treatment compared to placebo or 131 I treatment alone were collected. Two authors performed the data extraction independently.

RESULTS: Six RCTs involving 294 patients with MNG were included in this review. Altogether 168 patients were randomized to rhTSH-stimulated 131 I therapy, and 126 to either placebo and 131 I or 131 I alone. rhTSH-stimulated 131 I vs placebo and 131 I or 131 I alone for MNG showed no statistically significant difference in quality of life and all-cause mortality. rhTSH- (at a dose of 0.03 mg and above) stimulated 131 I treatment for MNG showed significant benefits in thyroid volume reduction. 131 I treatment with rhTSH stimulation at high doses (0.03 mg, 0.1 mg, 0.3 mg and 0.45 mg) for MNG caused significantly higher adverse effects and hypothyroidism.

CONCLUSIONS: The overall results indicated that using rhTSH at high doses of 0.03-0.45 mg before 131 I therapy resulted in a greater TVR than 131 I therapy alone for patients with non-toxic MNG. However, an increased incidence of adverse effects and hypothyroidism was observed in patients receiving high-dose of rhTSH pretreatment than in patients who received low-dose rhTSH pretreatment. Therefore, a dose of 0.03 mg rhTSH pretreatment before 131 I therapy may be more potent than 131 I alone in treating patients with non-toxic MNG who either had a contraindication for or declined surgery.