There is no ideal treatment for the simple goiter. The treatment options in NMG is: surgery, I131, L-thyroxine or continous monitoring without therapy.
From 20002003 we evaluated 150 patients (120 women and 30 men) having their agings between 20 and 80 years with L-T4 treatment for nontoxic multinodular goiter. Duration of therapy was 3 years. The pacients was evaluated by clinical examination, level of TSH, free-T4, anti-TPO, thyroid sonography, scintigraphy, FNAB (in the evaluation of solitary nodule or a dominant nodule), ECG, DEXA (in postmenopausal woman. 28% (32 patients) were responders (reduction of the total nodular volume with > 50%); 22% (33 patients) were partial responders (reduction of the total nodular with 20-50%). ∼ 1/3 developed symptoms of thyrotoxicosis (atrial fibrillation and bone mineral loss).
Conclusion: L-T4 therapy have beneficial effect in patients with smaller nodules, but have side effects: subclinical hyperthyroidism with increased risk of atrial fibrillation and reduced bone density in ederly patients. L-T4 therapy for NMG have a low efficacy and is a life long treatment.
01 - 05 Apr 2006
European Society of Endocrinology