Recurrence of multinodular goiter (MNG) with intra-thoracic extension.
History of mild, intermittent asthma and chronic hypertension treated with ACEI, with no cardiovascular symptoms.
Her MNG was discovered 33 years before, treated with subtotal thyroidectomy, with benign changes on pathology examination.
Seven years ago she had a thyroid scintigram performed using 99mTc pertechnetate which revealed significant residual thyroid tissue extending to mediastinum, with globally decreased uptake.
She received no treatment at that time.
Two years later she presented with large MNG recurrence, surgery being contraindicated because of anatomic considerations.
Radiometabolic treatment was performed with 30 mCi of 131I in an attempt to reduce gland volume.
Teaching points:
Recombinant human TSH (rhTSH)-stimulated iodine scintigraphy is an effective and safe alternative to thyroid hormone withdrawal,to be used during the post-surgical follow-up of papillary and follicular thyroid cancer.
Its clinical efficiency for the detection of persistent and recurrent disease is similar to that of thyroid hormone withdrawal.
As a novel clinical application, compressive goiters with benign changes and low uptake of 131I can be efficiently treated with the use of rhTSH.
Recombinant human TSH-stimulated radioiodine therapy of nodular goiter allows major reduction of the radiation burden with retained efficacy.