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Evolution of benign thyroid nodules under levothyroxine non-suppressive therapy

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Abstract

Background

Non-suppressive or partially suppressive L-T4 treatment demonstrated to be effective in reducing the volume of the nodules. However, studies with long follow-up are lacking and significant controversy exists regarding the efficacy of non-suppressive L-T4 treatment in benign nodular goiter.

Aim

The goal of this study was to determine the evolution of thyroid nodules in subjects treated with a non-suppressive levothyroxine (L-T4) dose, compared to untreated subjects.

Design and patients

We followed for a period of 1–9 years the thyroid nodule size in 356 female patients in the age range 19–45 at study entry, of which 201 untreated (Group 0) and 165 treated with a non-suppressive L-T4 dose (Group L-T4).

Measurements

We determined the volume of thyroid nodules by ultrasonography.

Results

The initial mean nodule volume in Group 0 and Group L-T4 was 3.91 ± 6.87 and 4.01 ± 7.35 mL, respectively. Nodule volume increase was inversely correlated to the initial volume. The final volume was slightly higher in untreated than in L-T4 treated subjects (5.37 ± 8.49 and 4.39 ± 6.72 mL). In both groups, the mean of annual fold increase of nodule volume was inversely correlated with the follow-up duration (P < 0.0046), indicating a slower growth as time advances. In the subjects treated with L-T4, the mean annual increase of nodule volume was significantly minor compared to untreated subjects. Concomitant nodules in ten multinodular goiters exhibited totally independent evolution, demonstrating that intranodular factors are more important for the nodule behavior than extra nodular factors.

Conclusions

Our study demonstrates that the growth of benign thyroid nodules is inversely correlated to their size, benign nodules naturally growth slowly as time advances, and that a chronic treatment with L-T4 at a non-TSH-suppressive dose significantly reduces their growth.

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Conflict of interest

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Authors and Affiliations

  1. Department of Medicine and Surgery, University of Salerno, Via Allende, Baronissi, 84081, Salerno, Italy

    Alessandro Puzziello, Pio Zeppa & Mario Vitale

  2. S.C. Endocrinologia, AOU San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy

    Mario Carrano & Elisabetta Angrisani

  3. Department of Clinical Medicine and Surgery, University “Federico II”, Naples, Italy

    Vincenzo Marotta & Antongiulio Faggiano

Authors
  1. Alessandro Puzziello
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  2. Mario Carrano
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  3. Elisabetta Angrisani
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  4. Vincenzo Marotta
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  5. Antongiulio Faggiano
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  6. Pio Zeppa
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  7. Mario Vitale
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Correspondence to Mario Vitale.

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Puzziello, A., Carrano, M., Angrisani, E. et al. Evolution of benign thyroid nodules under levothyroxine non-suppressive therapy. J Endocrinol Invest 37, 1181–1186 (2014). https://doi.org/10.1007/s40618-014-0128-z

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  • DOI: https://doi.org/10.1007/s40618-014-0128-z

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