More Evidence that there Really is an Alternative to Surgery . . .

The big news this month is the publication of a paper in the USA, that adds more evidence that there really is an alternative to surgery for Goiters that are either Autonomous or Euthroid. My colleagues in Florida and Arizona, doctors Duick and Baskin, reported on their cases of goiters with low iodine uptakes, which is common in this country, due to relative higher iodine intakes, with augmentation of the uptake with Thyrogen, allowing therapy with radio-iodine I/131 to shrink goiters that were enlarging, and causing symptoms, or mildly hyperthyroid.

They reported their findings in the May/June Endocrine Practice Vol.9 Number 3 2003, page 204-209. The high intake of iodine in the USA, has limited the use and ability to relieve symptoms, and shrink the thyroid gland, and correct autonomy in patients with suppressed TSH by radio-iodine I/131. The release of recombinant human TSH, or rhTSH, by Genzyme has given us a new approach in our country to this problem. The results are similar to results in my center since the release of Thyrogen, (rhTSH).

16 cases were studied.

Results:

1. All 10 with compressive symptoms had relief.
2. Both patients with weight loss returned to normal weight.
3. All patients with suppressed TSH became normal or hypothyroid.
4. The average gland size decreased 30-40% in the next six months.
5. 9/16 patients became hypothyroid after the Thyrogen/ I 131 therapy.
6. 1/2 patients with atrial fibrillation converted.
7. 1/16 cases had mild pain over the thyroid gland.
8. No other complications.

The Santa Monica Thyroid Center has been treating elderly patients with large goiters with radio-iodine after Thyrogen stimulated uptake since 1999, when Thyrogen was released. They were too ill to have surgery for their obstructive goiter. We have expanded this to all patients with large goiters as an alternative to surgery. The complications are rare. Mild radiation induced pain occurred in a few cases, but no other major or minor complications have occurred in large simple goiters.

It is time to stop the progressive growth of your goiter. Studies show the goiter will grow, and will cause you trouble in the future. Hyperthyroidism, obstruction, nodules with possible cancer potential needing biopsy and possible surgery, all are possibly in your future, the dangers of high dose thyroid hormone to treat your goiter to relieve obstruction is well known.
Atrial fibrillation, a heart irregular beating, and bone loss, possibly leading to osteoporosis are possible complications.

I will evaluate you for consideration of Radio-Iodine Therapy with or without Thyrogen Augmentation of the Iodine uptake, for your large goiter, with either mild hyperthyroidism, and or compression symptoms.

If you have other illnesses that make surgery risky, or you are an increased risk due to age 60 years old, then this is the best therapy for you.

Call me at my center and talk to Sandy, Imelda, or Jan about an appointment.

Remember, thyroid disease, especially goiter is a slow progressive disease with few symptoms until it is very advanced, causing heart disease, respiratory problems, worrisome possible nodules, and washed out bones and hip fractures.