Why Do Clinicians Continue to Debate the Use of Levothyroxine in the Diagnosis and Management of Thyroid Nodules?
Authors: Manfred Blum
Journal: Annals of Internal Medicine (1995)

Editorials1 January 1995Why Do Clinicians Continue to Debate the Use of Levothyroxine in the Diagnosis and Management of Thyroid Nodules?Manfred Blum, MDManfred Blum, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-122-1-199501010-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Why do clinicians still debate whether thyroid nodule volume decreases in response to therapy with levothyroxine, given that many types of nodules do not get smaller and that the therapy could have adverse effects [1]? The reasons include the enormous number of patients with enlarged thyroids, the myriad clinical variations of the condition, insecurity about clinical findings, exceptions to current diagnostic guidelines that identify malignancy, and questions about the long-term management of benign nodules or the contralateral lobe after surgery.Suppressive therapy, in which thyroid hormone is administered to reduce the concentration of thyroid-stimulating hormone (TSH) to a level below ...References1. Leinung MC. Levothyroxine therapy (Letter). Ann Intern Med. 1994; 120:619. Google Scholar2. Astwood EB, Cassidy CE, Aurbach GD. Treatment of thyroid goiter and nodules with thyroid. JAMA. 1960; 174:459-64. Google Scholar3. Thomas CG Jr, Buckwalter JA, Staab EV, Kerr CY. Evaluation of dominant thyroid masses. Ann Surg. 1976; 183:463-9. Google Scholar4. Blum M, Rothschild M. Improved nonoperative diagnosis of the solitary “cold” thyroid nodule. Surgical selection based on risk factors and three months of suppression. JAMA. 1980; 243:242-5. Google Scholar5. Gharib H, James EM, Charboneau JW, Naessens JM, Offord KP, Gorman CA. Suppressive therapy with levothyroxine for solitary thyroid nodules. A double-blind controlled clinical study. N Engl J Med. 1987; 317:70-5. Google Scholar6. Reverter JL, Lucas A, Salinas I, Aud L, Foz M, Sanmart A. Suppressive therapy with levothyroxine for solitary thyroid nodules. Clin Endocrinol (Oxf). 1992; 36:25-8. Google Scholar7. Ross DS, Neer RM, Ridgway EC, Daniels GH. Subclinical hyperthyroidism and reduced bone density as a possible result of prolonged suppression of the pituitary-thyroid axis with l-thyroxine. Am J Med. 1987; 82:1167-70. Google Scholar8. Paul TL, Kerrigan J, Kelly AM, Braverman LE, Baran DT. Long-term l-thyroxine therapy is associated with decreased hip bone density in premenopausal women. JAMA. 1988; 259:3137-41. Google Scholar9. Solomon BL, Wartofsky L, Burman KD. Prevalence of fractures in postmenopausal women with thyroid disease. Thyroid. 1993; 3:17-23. Google Scholar10. Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med. 1993; 118:282-9. Google Scholar11. Papini E, Bacci V, Panunzi C, Pacella CM, Fabbrini R, Bizzarri G, et al. A prospective randomized trial of levothyroxine suppressive therapy for solitary thyroid nodules. Clin Endocrinol (Oxf). 1993; 38:507-13. Google Scholar12. Morita T, Tamai H, Ohshima A, Komaki G, Matsubayaski S, Kuma K, et al. Changes in serum thyroid hormone, thyrotropin and thyroglobulin concentrations during thyroxine therapy in patients with solitary thyroid nodules. J Clin Endocrinol Metab. 1989; 69:227-30. Google Scholar13. La Rosa GL, Lupo L, Giuffrida D, Gullo D, Vigneri, R, Belfiore A. Levothyroxine and iodine are both effective for treating benign solitary solid cold nodules of the thyroid. Ann Intern Med. 1995; 122:1-8. Google Scholar14. Studer H, Peter HJ, Gerber H. Natural heterogeneity of thyroid cells: the basis for understanding thyroid function and nodular goiter growth. Endocr Rev. 1989; 10:125-35. Google Scholar15. Westermark K, Westermark B, Karlsson FA, Ericson LE. Location of epidermal growth factor receptors on porcine thyroid follicle cells and receptor regulation by thyrotropin. Endocrinology. 1986; 118:1040-6. Google Scholar16. Vassart G. TSH receptor as a member of the seven transmembrane family. 76th Annual Meeting of the Endocrine Society, Anaheim, California; 1994. Google Scholar17. Duick DS, Stein RB, Warren DW, Nicoloff JT. Significance of partial suppressibility of serum thyroxine by triiodothyronine administration in euthyroid man. J Clin Endocrinol Metab. 1975; 41:229-34. Google Scholar18. Blum M, Goldman AB, Herskovic A, Hernberg J. Clinical applications of thyroid echography. N Engl J Med. 1972; 287:1164-9. Google Scholar19. Spencer CA, Lai-Rosenfeld AO, Guttler RB, LoPresti J, Marcus AO, Nimalusurya A, et al. Thyrotropin secretion in thyrotoxic and thyroxine-treated patients: assessment by a sensitive immunoenzymometric assay. J Clin Endocrinol Metab. 1986; 63:349-55. Google Scholar20. Burmeister LA, Goumaz MO, Mariash CN, Oppenheimer JH. Levothyroxine dose requirements for thyrotropin suppression in the treatment of differentiated thyroid cancer. J Clin Endocrinol Metab. 1992; 75:344-50. 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