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Slow growth of benign thyroid nodules after menopause: no need for long-term thyroxine suppressive therapy in post-menopausal women

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Abstract

Benign thyroid nodules represent a very common disorder, the management of which is still controversial. The aim of the present work was to evaluate by ultrasound examination the volume changes of thyroid nodules in post-menopausal women presenting single palpable nodular goiter of recent onset (less than 6 months from diagnosis). Forty-three patients received L-T4-treatment, 38 represented the no-treatment group. Long-term follow up (3 and 5 yr) did not show any significant change in the mean volume nodule in these patients. In the no-treatment group, the mean nodule volumes were stable over time from baseline to 5 yr. No significant difference was observed at any follow-up evaluation between thyroid hormone treated and untreated patients. After 1 yr of treatment, a significant decrease (p=0.0275) in mean nodule volume occurred only for nodules with a baseline volume lower than 1.5 ml. The frequency of clinically relevant nodule size variation showed a more frequent decrease (13.9%) at 1 yr in the L-T4 group, as compared to the no-treatment group (2.6%), while the proportion of increased volume at 1 yr was higher in the untreated than in the L-T4 group (5.3% vs 2.3%). This inverse relationship between the 2 groups was not statistically significant (p=0.076). In conclusion, an arrest in the growth of benign thyroid nodules occurs in the majority of women after menopause. Only a very limited number of these patients may benefit from thyroid hormone suppressive treatment.

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References

  1. Rojeski MT, Gharib H. Nodular thyroid disease. Evaluation and management. N Engl J Med 1985, 313: 428–36.

    Article  CAS  PubMed  Google Scholar 

  2. Aghini-Lombardi F, Antonangeli L, Martino E, et al. The spectrum of thyroid disorders in an iodine-deficient community: the Pescopagano survey. J Clin Endocrinol Metab 1999, 84: 561–6.

    CAS  PubMed  Google Scholar 

  3. Scheible W, Leopold GR, Woo VL, et al. High-resolution real-time ultrasonography of thyroid nodules. Radiology 1979, 133: 413–7.

    CAS  PubMed  Google Scholar 

  4. Solbiati L, Volterrani L, Rizzatto G, et al. The thyroid gland with low uptake lesions: evaluation by ultrasound. Radiology 1985, 155: 187–91.

    CAS  PubMed  Google Scholar 

  5. Tan GH, Gharib H, Reading CC. Solitary thyroid nodule. Comparison between palpation and ultrasonography. Arch Intern Med 1995, 155: 2418–23.

    Article  CAS  PubMed  Google Scholar 

  6. Giuffrida D, Gharib H. Controversies in the management of cold, hot, and occult thyroid nodules. Am J Med 1995, 99: 642–50.

    Google Scholar 

  7. Cooper DS. Clinical review 66: Thyroxine suppression therapy for benign nodular disease. J Clin Endocrinol Metab 1995, 80: 331–4.

    CAS  PubMed  Google Scholar 

  8. La Rosa GL, Lupo L, Giuffrida D, Gullo D, Vigneri R, Belfiore A. Levothyroxine and potassium iodide are both effective in treating benign solitary solid cold nodules of the thyroid. Ann Intern Med 1995, 122: 1–8.

    Article  PubMed  Google Scholar 

  9. Papini E, Petrucci L, Guglielmi R, et al. Long-term changes in nodular goiter: a 5-yr prospective randomized trial of levothyroxine suppressive therapy for benign cold thyroid nodules. J Clin Endocrinol Metab 1998, 83: 780–3.

    Article  CAS  PubMed  Google Scholar 

  10. Gharib H, Mazzaferri EL. Thyroxine suppressive therapy in patients with nodular thyroid disease. Ann Intern Med 1998, 128: 386–94.

    Article  CAS  PubMed  Google Scholar 

  11. Ross DS. Thyroid hormone suppressive therapy for thyroid nodules and benign goiter. Up To Date in Endocrinology 2002. http://www.uptodate.com/totm/JCEM/Sept_02/topics/8267S3.htm.

    Google Scholar 

  12. Hegedus L, Bonnema SJ, Bennedbaek FN. Management of simple nodular goiter: current status and future perspectives. Endocr Rev 2003, 24: 102–32.

    Article  PubMed  Google Scholar 

  13. Gharib H, James EM, Charboneau JW, Naessens JM, Offord KP, Gorman CA. Suppressive therapy with levothyroxine for solitary thyroid nodules. A doubleblind controlled clinical study. N Engl J Med 1987, 317: 70–5

    Article  CAS  PubMed  Google Scholar 

  14. Reverter JL, Lucas A, Salinas I, Audi L, Foz M, Sanmarti A. Suppressive therapy with levothyroxine for solitary thyroid nodules. Clin Endocrinol (Oxf) 1992, 36: 25–8.

    Article  CAS  Google Scholar 

  15. Castro MR, Caraballo PJ, Morris JC. Effectiveness of thyroid hormone suppressive therapy in benign solitary thyroid nodules: a meta-analysis. J Clin Endocrinol Metab 2002, 87: 4154–9.

    Article  CAS  PubMed  Google Scholar 

  16. Zelmanovitz F, Genro S, Gross JL. Suppressive therapy with levothyroxine for solitary thyroid nodules: a doubleblind controlled clinical study and cumulative meta-analyses. J Clin Endocrinol Metab 1998, 83: 3881–5.

    CAS  PubMed  Google Scholar 

  17. Bennedbaek FN, Hegedus L. Management of the solitary thyroid nodule: results of a North American survey. J Clin Endocrinol Metab 2000, 85: 2493–8.

    Article  CAS  PubMed  Google Scholar 

  18. Bonnema SJ, Bennedbaek FN, Wiersinga WM, Hegedus L. Management of the nontoxic multinodular goitre: a European questionnaire study. Clin Endocrinol (Oxf) 2000, 53: 5–12.

    Article  CAS  Google Scholar 

  19. Wémeau JL, Caron P, Schvartz C, et al. Effects of thyroidstimulating 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. J Clin Endocrinol Metab 2002, 87: 4928–34.

    Article  PubMed  Google Scholar 

  20. Sawin CT, Geller A, Wolf PA, et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med 1994, 331: 1249–52.

    Article  CAS  PubMed  Google Scholar 

  21. Biondi B, Fazio S, Cuocolo A, et al. Impaired cardiac reserve and exercise capacity in patients receiving long-term thyrotropin suppressive therapy with levothyroxine. J Clin Endocrinol Metab 1996, 81: 4224–8.

    CAS  PubMed  Google Scholar 

  22. Biondi B, Fazio S, Coltorti F, et al. Clinical case seminar: Reentrant atrioventricular nodal tachycardia induced by levothyroxine. J Clin Endocrinol Metab 1998, 83: 2643–5.

    Article  CAS  PubMed  Google Scholar 

  23. Ross DS, Neer RM, Ridgway EC, Daniels GH. Subclinical hyperthyroidism and reduced bone density as a possible result of prolonged suppression of the pituitary-thyroid axis with L-thyroxine. Am J Med 1987, 82: 1167–70.

    Article  CAS  PubMed  Google Scholar 

  24. Uzzan B, Campos J, Cucherat M, Nony P, Boissel JP, Perret GY. Effects on bone mass of long term treatment with thyroid hormones: a meta-analysis. J Clin Endocrinol Metab 1996, 81: 4278–89.

    CAS  PubMed  Google Scholar 

  25. Costante G, Grasso L, Ludovico O, et al. The statistical analysis of neonatal TSH results from congenital hypothyroidism screening programs provides a useful tool for the characterization of moderate iodine deficiency regions. J Endocrinol Invest 1997, 20: 251–6.

    Article  CAS  PubMed  Google Scholar 

  26. Costante G, Grasso L, Schifino E, et al. Iodine deficiency in Calabria: characterization of endemic goiter and analysis of different indicators of iodine status region-wide. J Endocrinol Invest 2002, 25: 201–7.

    Article  CAS  PubMed  Google Scholar 

  27. Hegedus L, Perrild H, Poulsen LR, et al. The determination of thyroid volume by ultrasound and its relationship to body weight, age, and sex in normal subjects. J Clin Endocrinol Metab 1983, 56: 260–3.

    Article  CAS  PubMed  Google Scholar 

  28. Kuma K, Matsuzuka F, Yokozawa T, Miyauchi A, Sugawara M. Fate of untreated benign thyroid nodules: results of long-term follow-up. World J Surg 1994, 18: 495–8.

    Article  CAS  PubMed  Google Scholar 

  29. Morita T, Tamai H, Ohshima A, et al. Changes in serum thyroid hormone, thyrotropin and thyroglobulin concentrations during thyroxine therapy in patients with solitary thyroid nodules. J Clin Endocrinol Metab 189, 69: 227–30.

  30. Derwahl M, Broecker M, Kraiem Z. Clinical review 101: Thyrotropin may not be the dominant growth factor in benign and malignant thyroid tumors. J Clin Endocrinol Metab 1999, 84: 829–834

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Deparment of Clinical and Experimental Medicine, University of Catanzaro, Via Tommaso Campanella, 115, 88100, Catanzaro, Italy

    G. Costante MD, U. Crocetti, E. Schifino, O. Ludovico, C. Capula, M. Nicotera, F. Arturi & S. Filetti

  2. Department of Clinical Sciences, University of Rome “La Sapienza”, Rome, Italy

    S. Filetti

  3. Division of Endocrinology, “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo, Italy

    U. Crocetti & O. Ludovico

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  1. G. Costante MD
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  2. U. Crocetti
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  3. E. Schifino
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  4. O. Ludovico
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  5. C. Capula
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Correspondence to G. Costante MD.

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Costante, G., Crocetti, U., Schifino, E. et al. Slow growth of benign thyroid nodules after menopause: no need for long-term thyroxine suppressive therapy in post-menopausal women. J Endocrinol Invest 27, 31–36 (2004). https://doi.org/10.1007/BF03350907

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