title: Solitary nodular disease and multinodular goiter: a retrospective study on suppressive versus replacement levothyroxine therapy.
abstract: The aim of the present study was to ascertain whether patients affected by solitary nodular disease of the thyroid or multinodular goiter had a different clinical outcome when treated with suppressive levo-thyroxine (L-T4) therapy rather than replacement L-T4 therapy. We evaluated, by a retrospective analysis, 36 patients who had received TSH-suppressive L-T4 therapy according to TSH value and 55 who had received replacement L-T4 therapy. Fine needle aspiration cytology and thyroid scan after 131I were evaluated before L-T4 administration, while echographic monitoring of number and dimensions of nodules was recorded prior to and during L-T4 treatment. No difference in duration of L-T4 treatment (about 3 years) was registered between the TSH-suppressive therapy group and replacement therapy group. L-T4 administration in a TSH-suppressive or replacement manner did not induce a numerical or volumetric significant decrease of the main nodule or of the total nodule volume. Our data show that chronic TSH-suppressive therapy does not seem to be better than replacement therapy. Moreover, TSH-suppressive therapy presented a higher risk of adverse events than replacement therapy, thus requiring a more careful check with a higher cost of care.
authors.affiliation: 2nd Medical Clinic, University La Sapienza-Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Paggi
authors.forename: C
authors.initials: C
authors.lastname: Persegani-Trimarchi
authors.forename: P
authors.initials: P
authors.lastname: Russo
authors.forename: M
authors.initials: M
authors.lastname: Mastropasqua
authors.forename: M A
authors.initials: MA
authors.lastname: Mosetti
authors.forename: T
authors.initials: T
authors.lastname: Losi
authors.forename: O
authors.initials: O
authors.lastname: Leri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004305:Dose-Response Relationship, Drug; D005260:Female; D006044:Goiter, Nodular / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D020249:Hormone Replacement Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013963:Thyroid Hormones / Q000097:blood; D013972:Thyrotropin / Q000097:blood*; D013974:Thyroxine / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D013963:Thyroid Hormones; D013972:Thyrotropin; D013974:Thyroxine