LETTER
Thyroxine or Iodine Therapy for Thyroid Nodules
Joseph Di Poala Sr.
1 August 1995 | Volume 123 Issue 3 | Pages 235-236
TO THE EDITOR:
I read with interest the article by La Rosa and colleagues [1], which described the treatment of benign solitary solid cold nodules of the thyroid. I question the authors' rationale for treatment. Presuming that these nodules are completely asymptomatic and truly benign, this management strategy is preventive rather than therapeutic. According to the U.S. Preventive Task Force recommendations, performance of a preventive service is based on the quality of evidence that this service results in more good than harm [2].
After the thyroid nodule is determined to be benign by fine-needle aspiration—which has been proved to be safe, accurate, and cost-effective [3]—three possibilities exist for the future course of this nodule:
1. It can remain benign at the same, smaller, or larger size. (Untreated thyroid nodules disappear in 38% of cases, and only 13% of nodules increase in size [4].)
2. New satellite benign nodules can form.
3. Cancer can develop within the nodule or outside the nodule in another part of the thyroid gland.
Because no scientific evidence in La Rosa and colleagues' study or in other studies suggests that thyroid replacement prevents malignancy or improves health or longevity, we must turn to its potential harmful effects. Thyroid replacement dosage, if not carefully adjusted, can lead to osteoporosis or thyrotoxic heart disease. Additional harm includes the cost of the medication, follow-up laboratory testing, and the inconvenience to the patient resulting from lifelong medication use.
Mayo Clinic proceedings conclude that the role of levothyroxine therapy remains uncertain and is not recommended [5]. I therefore conclude that, until further data accumulate, thyroid replacement is unjustified in the treatment of benign thyroid nodules.
1. La Rosa GL, Lupo L, Giuffrida D, Gullo D, Vigneri R, Belfiore A. Levothyroxine and potassium iodide are both effective in treating benign solitary cold nodules of the thyroid. Ann Intern Med. 1995; 122:1-8.[Abstract/Free Full Text]
2. Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions. Report of the U.S. Preventive Services Task Force. Baltimore: Williams & Wilkins; 1989.
3. Gharib H, Goellner R. Fine needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med. 1993; 118:282-9.
4. Kuma K, Matsuzuka F, Kobayaski A, Hirai K, Morita S, Miyauchi A, et al. Outcome of long standing solitary thyroid nodules. World J Surg. 16:583-7.
5. Gharib H. Fine needle aspiration biopsy of thyroid nodules: advantages, limitations, and effect. Mayo Clin Proc. 1994; 69:44-9.
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