Levothyroxine therapy in preventing nodular recurrence after hemithyroidectomy: a retrospective study.
OBJECTIVE
To determine the effect of levothyroxine (L-T4) therapy on the recurrence rate of nodular disease in patients previously treated with lobectomy for benign nodular goiter.


METHODS
Two hundred and thirty-tree patients (38 males, 195 females; age 49.9+/-13.1 yr) with no post-surgical evidence of nodular disease in the remnant, were followed- up yearly with serum TSH and ultrasound (US). Nodular recurrence was defined as a lesion of at least 5 mm at US. Patients were divided in 2 groups based on whether or not they had been treated with L-T4 after surgery: Group 1 (45 patients) who did not receive any L-T4, and Group 2 (188 patients) treated with L-T4. Group 2 was further subdivided in Group 2a (123 patients) receiving L-T4 substitutive therapy (TSH>or=0.5 and <or=3 mUI/l) and Group 2b (65 patients) receiving L-T4 at TSH-suppressive dose (TSH<0.5 mUI/l).


RESULTS
Mean observation period was 5.8+/-4.7 yr. Overall, 71 out of 233 (30.5%) patients experienced recurrence of thyroid nodular disease: 29 patients (64.4%) in Group 1, 24 (19.5%) patients in Group 2a, and 18 (27.7%) patients in Group 2b. The recurrence rate was significantly lower (p<0.001) in Group 2 compared with Group 1, but no significant difference was observed between Groups 2a and 2b.


CONCLUSIONS
In patients who have undergone hemithyroidectomy for benign monolobar nodular disease, L-T4 therapy may prevent recurrence of nodular disease. TSH suppression may not be required for prevention of recurrence in the remnant thyroid tissue.
Alba
M
M
Endocrinology Unit, Catholic University of Sacred Heart, Via Federico Cesi, 72, 00193 Rome, Italy.
Fintini
D
D
Lovicu
R M
RM
Paragliola
R M
RM
Papi
G
G
Rota
C A
CA
Pontecorvi
A
A
Corsello
S M
SM
D005260:Female; D006044:Goiter, Nodular / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000188:drug therapy* / Q000601:surgery; D013965:Thyroidectomy; D013974:Thyroxine / Q000627:therapeutic use*; D016896:Treatment Outcome
D013974:Thyroxine