Nodules After RAI Therapy of TMNG

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Question

I believe RAI is the better option for toxic multinodular goiter. Can you comment on situations when 1) nodules become bigger year(s) post RAI, or minimal change if at all? 2) growth of new nodules post RAI. These patients are already on replacement doses of Lt4 for hypothyroidim(post ablation).I wonder if the kind of nodules affect treatment outcome? Does RAI affect solid nodules ,complex, or cystic nodules differently. Thanks very much for your sharing your expertise.

Lynn Bilar,MD

Response

1) The 131I scan of patients with MNG almost invariably shows a mixed picture of hot, low-uptake and even cold area’s. These cold area’s often, but not always, begin to show uptake after the other nodules have disappeared or at least shrunken by previous dose(s) of 131I. In other words if patients still have remaining or even growing nodules after 131I treatment, it means either that insufficient attention has been given to the possibility that cold nodules may start to take–up 131I after irradication of initially active nodules, or that nodules remain cold indicating structurally absence of uptake capacity. Then surgical treatment is only necessary when serious compressive complaints remain. 2) RAI only affects nodules that show uptake capacity for 131I. Most non-malignant solid or mixed nodules do, but the latter to a lesser extent. A pure cystic nodule, does not. Georg Hennemann, MD Note added- Nodules growing after RAI treatment of TMNG must raise the question of malignancy, and deserve evaluation from that point of view.

L De Groot,MD