LETTER
Levothyroxine Therapy
Matthew C. Leinung, MD
1 April 1994 | Volume 120 Issue 7 | Pages 619-620
TO THE EDITOR:
I take exception to the outdated recommendation in the otherwise excellent review of thyroid hormone use [1] for using levothyroxine to temporarily suppress solitary, nonfunctioning, benign nodules [2, 3]. The authors admit that randomized controlled trials do not show any benefit of levothyroxine use over placebo in shrinking nodules. What, then, is being accomplished? Because thyroid cancers respond to levothyroxine therapy, those whose nodules shrink, still require observation and possible repeat biopsy [2]. Surgery is generally recommended if the nodule grows, whether or not the patient is receiving levothyroxine. If the size of the nodule remains unchanged, management is the same, regardless of suppressive therapy (that is, observation and perhaps future repeat biopsy). Thus, patient management is essentially unchanged. Furthermore, no data indicate a better outcome (fewer thyroidectomies or a lower rate of malignant transformation) with suppressive therapy.
One potential indication for suppressive therapy is when surgical removal is being considered for size alone because shrinkage of the nodule might prevent surgery. Short-term levothyroxine therapy may not always be benign [4], and the potential benefits must outweigh the risk.
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Author and Article Information
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Albany MEdical College; Albany, NY 12208
1. Mandel, SJ, Brent GA, Larsen PR. Levothyroxine therapy in patients with thyroid disease. Ann Intern Med. 1993; 119:492-502.[Abstract/Free Full Text]
2. Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med. 1992; 118:282-9.
3. Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med. 1993; 328:553-9.
4. Featherstone HJ, Stewart DK. Angina in thyrotoxicosis: thyroid related coronary artery spasm. Arch Intern Med. 1983; 143:554-5.
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