THE USE of radioiodine as the preferred therapy for toxic nodular goiter (TNG) is still controversial. Many investigators remain opposed to this approach.1-16 Usually radioiodine is used only if the patient refuses surgery or if surgery is contraindicated. Only a few investigators favor radioiodine therapy for TNG.17-21 Silver21 is included among them but even in his extensive paper he dealt mostly with small goiters. The estimated average weight was 53 gm, and only 22 of 282 patients had goiters larger than 110 gm.
Good results have been reported with the use of radioiodine therapy for TNG. Good results were obtained even by those who argue against its use,4,6,7,10-16 and even with large multinodular goiters, including those with tracheal compression.15,16,19
Solitary autonomous hyperfunctioning nodules are excluded from this study. Our approach to the diagnosis and management of this intriguing lesion has been published.22,23 This paper offers experience with patients with large