Thyroid nodules patients should not be treated with L-thyroxine except in selected cases.

Thyroid nodules patients should not be treated with L-thyroxine except in selected cases.

Type of practice

Drugs

Age

Adult, Geriatric

Topic Area

Endocrinology

The growth of thyroid nodules, the appearance of other nodules and the increase in thyroid volume can be partially prevented by treatment with levo-thyroxine for TSH-suppressive purposes. However, a clinically significant volume reduction is achieved only with long-term therapies and in a minority of patients (small, recently diagnosed colloid nodules). The growth of the nodules is in fact influenced not only by TSH but also by other growth factors. Furthermore, suppressive therapy with l-thyroxine creates a condition of subclinical thyrotoxicosis which can be risky especially for women in menopause (favoring osteoporosis) and for the elderly (for the possible worsening of pre-existing heart disease or the onset of atrial fibrillation). This therapy can therefore be considered only in young subjects, in selected cases, while, if already in progress, it must be suspended in the case of menopausal women and elderly subjects, re-evaluating the thyroid function over time.

Sources

1. Gharib H, Mazzaferri EL. Thyroxine suppressive therapy in patients with nodular thyroid disease. Ann Intern Med. 1998;128:386-94.
2. Papini E, Petrucci L, Guglielmi R, et Al. Long-term changes in nodular goiter: a 5-year prospective randomized trial of levothyroxine suppressive therapy for benign cold thyroid nodules. J Clin Endocrinol Metab. 1998;83:780-83.
3. La Rosa GL, Ippolito AM, Lupo L, Cercabene G, Santonocito MG, Vigneri R, Belfiore A. Cold thyroid nodule reduction with L-thyroxine can be predicted by initial nodule volume and cytological characteristics. Clin Endocrinol Metab. 1996;81:4385-7.
4. Durante C, Costante G, Lucisano G, et Al.. The natural history of benign thyroid nodules. JAMA. 2015 Mar 3;313(9):926-35.
5. Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedus L, Vitti P, and the AACE /AME/ETA Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists (AACE), Associazione Medici Endocrinologi (AME), and European Thyroid Association (ETA) medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. J Endocrinol Invest executive summary 2010, 33: 287.

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