Endocrine Abstracts

Background: Treatment options for patients with toxic multinodular goitre (TMNG) include antithyroid medications, thyroidectomy, and radioactive iodine (RAI) therapy. Our aim was to investigate the efficacy of RAI alone compared to combination therapy that includes RAI with medical therapy.

Methods: Search was performed using MEDLINE, MEDLINE In-Process (PubMed platform), Embase (Elsevier platform), BIOSIS and Cochrane was performed. Randomized controlled trails (RCTs) and prospective cohort studies were included that explored efficacy of radioiodine treatment for TMNG in adults aged over 18. Random effect meta-analysis was performed to estimate the efficacy of radioiodine therapy either as monotherapy or as combination therapy in achieving cure.

Results: 6 RCTs (364 participants) and 14 cohort studies (2117 participants) were eligible for final analysis. On comparing monotherapy to combination therapy of radioiodine in TMNG, pooled results from the RCT’s showed that monotherapy was found to have higher cure rates at 1 year (83.3% vs 67.5%; RR 1.14; 95% CI 0.93 to 1.40, I2= 70%, pheterogeneity<0•006), though not statistically significant (P=0.20). In the pooled results of 4 cohort studies where follow up was available for 1 year there was no difference in outcomes of cure rates between monotherapy or combination therapy (RR 1.11; 95% CI 0.93 to 1.33, I2= 81%, pheterogeneity<0•00001). In terms of recurrence at 1 year in RCT’s, monotherapy was associated with lower rates of recurrence (19.8% vs 27.6%; RR 0.58; 95% CI 0.32 – 1.04), P= 0.07. The rate of recurrence from the pooled cohort studies undergoing monotherapy was 12%. Only 1 study reported on recurrence rates from combination therapy. In terms of side effects only 2 RCT’s reported a 10% nausea rate following RAI.

Conclusions: RAI monotherapy in comparison to combination therapy has better cure and lower recurrence rate in the treatment of toxic multinodular goitre.