Article    Table of Contents                    Full Text of this article Free    Figures/Tables List    Related articles in Annals  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Gharib, H.    Mazzaferri, E. L.    Related Articles in PubMed    PubMed Citation    PubMed

REVIEW

Thyroxine Suppressive Therapy in Patients with Nodular Thyroid Disease

Hossein Gharib, MD, and Ernest L. Mazzaferri, MD

1 March 1998 | Volume 128 Issue 5 | Pages 386-394

Purpose: To review evidence about thyroxine suppressive therapy in patients with thyroid nodules, including the clinical importance and natural history of nodules and the effects and potential side effects of thyroxine therapy.

Data Sources: English-language articles published from 1986 to December 1996 were identified through searches of the MEDLINE database, selected bibliographies, and personal files.

Data Extraction: Randomized, controlled trials and non-randomized trials of thyroxine suppressive therapy for solitary and predominantly solid thyroid nodules were reviewed. In most studies, nodule cytology was evaluated by fine-needle aspiration biopsy. Therapy was considered suppressive if suppression was documented by thyroid-stimulating hormone-releasing hormone tests or sensitive thyroid-stimulating hormone assays. Response was defined as a decrease of 50% or more in nodule size or volume; most recent studies measured nodule size by ultrasonography.

Data Synthesis: The evidence suggests that thyroxine suppressive therapy fails to shrink most nodules: Only 10% to 20% of nodules responded to this treatment. Fineneedle aspiration biopsy is more reliable in distinguishing benign from malignant nodules. Recent studies suggest that spontaneous decrease in size with complete disappearance of thyroid nodules is not uncommon. No data show that thyroxine therapy arrests further growth in most existing nodules or prevents the emergence of new nodules. Postoperative thyroxine therapy does not seem to prevent recurrence of thyroid nodules except in patients with a history of radiation therapy. Potential adverse effects of long-term suppressive therapy include osteoporosis and heart disease.

Conclusions: Patients with cytologically benign nodules are best followed without thyroxine treatment. Most benign nodules remain stable in size and remain benign when monitored for a long time. For nodules that increase in size, biopsy should be done again or surgery should be performed.

Author and Article Information

From the Mayo Clinic and Mayo Foundation, Rochester, Minnesota; and the Ohio State University College of Medicine and Health Sciences Center, Columbus, Ohio.
Requests for Reprints: Hossein Gharib, MD, Division of Endocrinology, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, MN 55905.
Current Author Addresses: Dr. Gharib: Division of Endocrinology, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, MN 55905.

Related articles in Annals:

Editorials
Medical Treatment of Benign Thyroid Nodules: Have We Defined a Benefit?
E. Chester Ridgway

Annals 1998 128: 403-405. [Full Text]  

This article has been cited by other articles:

				M Niedziela Pathogenesis, diagnosis and management of thyroid nodules in children. Endocr. Relat. Cancer, June 1, 2006; 13(2): 427 - 453. [Abstract] [Full Text] [PDF]

				L. Hegedus, S. J. Bonnema, and F. N. Bennedbaek Management of Simple Nodular Goiter: Current Status and Future Perspectives Endocr. Rev., February 1, 2003; 24(1): 102 - 132. [Abstract] [Full Text] [PDF]

				J.-L. Wemeau, P. Caron, C. Schvartz, J.-L. Schlienger, J. Orgiazzi, C. Cousty, and V. Vlaeminck-Guillem Effects of Thyroid-Stimulating Hormone Suppression with Levothyroxine in Reducing the Volume of Solitary Thyroid Nodules and Improving Extranodular Nonpalpable Changes: A Randomized, Double-Blind, Placebo-Controlled Trial by the French Thyroid Research Group J. Clin. Endocrinol. Metab., November 1, 2002; 87(11): 4928 - 4934. [Abstract] [Full Text] [PDF]

				R. Negro, D. Dazzi, and A. Pezzarossa The management of thyroid disease by GPs Fam. Pract., April 1, 2001; 18(2): 195 - 198. [Abstract] [Full Text] [PDF]

				M. H. Samuels Editorial: Evaluation and Treatment of Sporadic Nontoxic Goiter--Some Answers and More Questions J. Clin. Endocrinol. Metab., March 1, 2001; 86(3): 994 - 997. [Full Text]

				S. J. Bonnema, H. Bertelsen, J. Mortensen, P. B. Andersen, D. U. Knudsen, L. Bastholt, and L. Hegedus The Feasibility of High Dose Iodine 131 Treatment as an Alternative to Surgery in Patients with a Very Large Goiter: Effect on Thyroid Function and Size and Pulmonary Function J. Clin. Endocrinol. Metab., October 1, 1999; 84(10): 3636 - 3641. [Abstract] [Full Text] [PDF]

				S. L. Greenspan and F. S. Greenspan The Effect of Thyroid Hormone on Skeletal Integrity Ann Intern Med, May 4, 1999; 130(9): 750 - 758. [Abstract] [Full Text] [PDF]

				M. Derwahl, M. Broecker, and Z. Kraiem Thyrotropin May Not Be the Dominant Growth Factor in Benign and Malignant Thyroid Tumors J. Clin. Endocrinol. Metab., March 1, 1999; 84(3): 829 - 834. [Full Text]

				F. Zelmanovitz, S. Genro, and J. L. Gross Suppressive Therapy with Levothyroxine for Solitary Thyroid Nodules: A Double-blind Controlled Clinical Study and Cumulative Meta-analyses J. Clin. Endocrinol. Metab., November 1, 1998; 83(11): 3881 - 3885. [Abstract] [Full Text]