Non-toxic goitre
  The well established treatment of symptomatic non-toxic goitre is surgery. Due to the questionable efficacy of L-thyroxine therapy and the fact that many patients decline surgical therapy or are poor surgical candidates, a number of centers have started offering 131I-therapy to an increasing number of patients (2). Extent of this therapy and the pretreatment work-up of such a patient is presently debated. There is clearly no consensus on this, which will undoubtedly be demonstrated by the results of an ongoing ETA questionnaire investigation, to be presented at the ETA meeting in Milan, Italy, August 1999. Advantages and disadvantages of this therapy are given in table 4.


Table 4: Effects and side-effects of 131I-therapy for non-toxic goitre

Advantages
  • Diffuse non-toxic goitre
    Sixty-two percent reduction of thyroid volume within one year. Leads to normalization of thyroid volume in the majority of patients. Can be repeated.

  • Multinodular non-toxic goitre
    Fifty percent reduction of thyroid volume within one year. Can be repeated.

  • Autonomous nodule
    Very little data available. Probably very similar to that of solitary toxic nodules.

Disadvantages
  • Diffuse non-toxic goitre
    Only gradual decrease in thyroid volume and not always normalization. Theoretical risk of radiation thyroiditis and Graves’ disease. Hypothyroidism ~14% within one year. Little experience.

  • Multinodular non-toxic goitre
    Only gradual decrease in thyroid volume and rarely normalization. Radiation thyroiditis (3%); Graves’ disease (4%); hypothyroidism (20%) within 5 years. Needs to be repeated in some patients. Lack of histo-logical confirmation.

  • Autonomous nodule
    Very little data. Probably similar to that of solitary toxic nodules. Lack of histological confirmation.


For all subtypes it is evident that thyroid volume reduction is much slower and less pronounced than compared with surgery. Given the choice, the majority of Danish patients will choose 131I and not surgery. There is a theoretical risk of overlooking or inducing malignancy and of inducing ophthalmopathy.