This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints, Permissions and Rights Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wémeau, J.-L. Articles by Vlaeminck-Guillem, V. Search for Related Content PubMed PubMed Citation Articles by Wémeau, J.-L. Articles by Vlaeminck-Guillem, V.

Effects of Thyroid-Stimulating Hormone Suppression with Levothyroxine in Reducing the Volume of Solitary Thyroid Nodules and Improving Extranodular Nonpalpable Changes: A Randomized, Double-Blind, Placebo-Controlled Trial by the French Thyroid Research Group

Clinique Marc Linquette, Centre Hospitalier Régional et Universitaire de Lille (J.-L.W., V.V.-G.), F-59037 Lille cedex, France; Hôpital de Rangueil, Centre Hospitalier Universitaire de Toulouse (P.C.), F-31403 Toulouse, France; Institut Jean-Godinot (C.S.), F-51056 Reims, France; Centre Hospitalier Universitaire Hautepierre (J.-L.S.), F-67098 Strasbourg, France; and Centre Hospitalier Lyon Sud, Pierre-Bénite (J.O.), F-69495 Lyon (C.C.), France

Address all correspondence and requests for reprints to: Jean-Louis Wémeau, M.D., Clinique Marc Linquette, Centre Hospitalier Régional et Universitaire de Lille, 6 rue du Prof. Laguesse, F-59037 Lille cedex, France. E-mail: jl-wemeau{at}chru-lille.fr.

Abstract

The efficacy of suppressing TSH secretion with levothyroxine (L-T₄) in reducing solitary thyroid nodule growth is still controversial. In this prospective multicenter, randomized, double-blind, placebo-controlled trial, 123 patients with a single palpable benign nodule were included and randomly allocated to an 18-month treatment with L-T₄ or placebo. Individual dose was adjusted to allow a serum TSH level below 0.3 mIU/liter. Clinical and ultrasonographic nodule characteristics were assessed before treatment and 3, 6, 12, and 18 months thereafter.

The largest mean nodule size assessed on palpation and largest volume, assessed by ultrasonography, decreased in the L-T₄ group and increased slightly in the placebo group [size, -3.5 ± 7 mm vs. +0.5 ± 6 mm (P = 0.006); volume, -0.36 ± 1.71 ml vs. +0.62 ± 3.67 ml (P = 0.01), respectively]. The proportion of clinically relevant volume reduction (50%) rose significantly in the L-T₄ group [26.6% vs. 16.9% (P = 0.04)]. The proportion of patients with a reduced number of infraclinical additional nodules was significantly higher in the L-T₄ group [9.4% vs. 0 (P = 0.04)].

It is concluded from this study that suppressive L-T₄ therapy is effective in reducing solitary thyroid nodule volume and improving infraclinical extranodular changes.

This article has been cited by other articles:

				L. J. Layfield, E. S. Cibas, H. Gharib, and S. J. Mandel Thyroid Aspiration Cytology: Current Status CA Cancer J Clin, March 1, 2009; 59(2): 99 - 110. [Abstract] [Full Text] [PDF]

				H Gharib, E Papini, and R Paschke Thyroid nodules: a review of current guidelines, practices, and prospects Eur. J. Endocrinol., November 1, 2008; 159(5): 493 - 505. [Abstract] [Full Text] [PDF]

				B. Biondi and D. S. Cooper The Clinical Significance of Subclinical Thyroid Dysfunction Endocr. Rev., February 1, 2008; 29(1): 76 - 131. [Abstract] [Full Text] [PDF]

				M. R. Castro and H. Gharib Continuing Controversies in the Management of Thyroid Nodules Ann Intern Med, June 7, 2005; 142(11): 926 - 931. [Abstract] [Full Text] [PDF]

				K. Krohn, D. Fuhrer, Y. Bayer, M. Eszlinger, V. Brauer, S. Neumann, and R. Paschke Molecular Pathogenesis of Euthyroid and Toxic Multinodular Goiter Endocr. Rev., June 1, 2005; 26(4): 504 - 524. [Abstract] [Full Text] [PDF]