Treatment of benign cold thyroid nodules - adapted from the Annals of Internal Medicine, January 1,

Date: May 15, 1995

The prevalence of thyroid nodules detected on ultrasonography is 30 to 50 percent. Most nodules are cold on scintigraphy and represent a common management problem. Findings of fine-needle aspiration biopsy (detection of malignancy or inability to rule out malignancy) indicate the need for surgical excision in approximately 15 to 25 percent of cases. Clinical evaluation may suggest the need for surgery in another 5 percent. The majority of cold thyroid nodules are managed medically.

Levothyroxine, at dosages that suppress thyroid-stimulating hormone (TSH), is generally used in the treatment of these nodules because TSH is the major thyroid stimulator for both function and growth. Recent studies, however, have questioned the efficacy of levothyroxine and raised concern about associated decreases in bone mineral density. La Rosa and colleagues tested levothyroxine and potassium iodide treatment in patients with solitary cold thyroid nodules.

Eighty patients with benign solitary cold thyroid nodules with indications for medical treatment were divided into three groups. Patients in the first group received no treatment, the second group received oral levothyroxine, 1.0 [mu]g per kg of body weight per day taken as a single morning dose, and the third group received oral iodine supplementation at 1.5 mg every two weeks in the form of potassium iodide tablets. The levothyroxine supplementation in the second group was increased to allow a serum TSH level less than normal values.

Treatment compliance was good in all groups. At the end of the 12-month period, the mean nodule volume as determined by ultrasound was reduced by 40 percent in the patients receiving levothyroxine and by 23 percent in the patients receiving potassium iodide. In contrast, the mean nodule volume increased by 11 percent in the untreated patients.

The authors conclude that both levothyroxine and, to a lesser extent, potassium iodide, are effective in halting the growth or decreasing the volume of cold thyroid nodules. Nodules that increase in size with adequate levothyroxine therapy may require surgery. Potassium iodide may be useful in patients with small nodules and contraindications to levothyroxine. (Annals of Internal Medicine, January 1, 1995, vol. 199, p. 1.)

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