Suppressive therapy with thyroxine is the standard conservative treatment for solitary benign thyroid nodules. However, factors which may influence the response to treatment remains controversal, as well as the risc of thyroxine administration.
We prospectively evaluated the effects of twelve months thyroid-stimulating hormone suppression with Levothyroxine (L-T4) in reducing the volume of benign solitary nodules, and the effects of reduced serum TSH level on both cardiovascular system and bone loss in postmenopausal women. All of 52 patients were prescribed individual Thyroxine in a dose to keep TSH levels 0.30.5 mU/l. Clinical, laboratory, ultrasographic, cytological features of the nodules, were assessed before treatment, in three months interval, and after 12 months. Bone mass density was measured before treatment and in one year interval in postmenopausal woman. Cardiovascular parameters (BP, heart rate), and ECG were monitoring during 1 year period. The therapy was effective in 25.6% persons. In 5.76% persons nodules showed evolution, and in 74.4% persons there was no significant change during 1 year period. In group of responders, the mean reduction of volumen of nodules was 19%, homolateral lobus 6.4% and contralateral 3.5%. The best answer on therapy showed younger persons with colloid nodules. There were no adverse cardiovascular manifestations during 1 year therapy. Subclinical hyperthyroidism in postmenopausal woman did not result in accelerated bone loss.
In conclusion, we found suppressive L-T4 therapy in selected patients can be effective in reducing solitary thyroid nodule volume, and there is no risk of the administration of thyroxine in 1 year period.
03 - 07 May 2008
European Society of Endocrinology