Why Do Clinicians Continue to Debate the Use of Levothyroxine in the Diagnosis and Management of Thyroid Nodules?

Editorials1 January 1995Why Do Clinicians Continue to Debate the Use of Levothyroxine in the Diagnosis and Management of Thyroid Nodules?Manfred Blum, MDManfred Blum, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-122-1-199501010-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Why do clinicians still debate whether thyroid nodule volume decreases in response to therapy with levothyroxine, given that many types of nodules do not get smaller and that the therapy could have adverse effects [1]? The reasons include the enormous number of patients with enlarged thyroids, the myriad clinical variations of the condition, insecurity about clinical findings, exceptions to current diagnostic guidelines that identify malignancy, and questions about the long-term management of benign nodules or the contralateral lobe after surgery.Suppressive therapy, in which thyroid hormone is administered to reduce the concentration of thyroid-stimulating hormone (TSH) to a level below ...References1. Leinung MC. Levothyroxine therapy (Letter). Ann Intern Med. 1994; 120:619. Google Scholar2. Astwood EB, Cassidy CE, Aurbach GD. Treatment of thyroid goiter and nodules with thyroid. JAMA. 1960; 174:459-64. Google Scholar3. Thomas CG Jr, Buckwalter JA, Staab EV, Kerr CY. Evaluation of dominant thyroid masses. Ann Surg. 1976; 183:463-9. Google Scholar4. Blum M, Rothschild M. Improved nonoperative diagnosis of the solitary “cold” thyroid nodule. 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Spencer CA, Lai-Rosenfeld AO, Guttler RB, LoPresti J, Marcus AO, Nimalusurya A, et al. Thyrotropin secretion in thyrotoxic and thyroxine-treated patients: assessment by a sensitive immunoenzymometric assay. J Clin Endocrinol Metab. 1986; 63:349-55. Google Scholar20. Burmeister LA, Goumaz MO, Mariash CN, Oppenheimer JH. Levothyroxine dose requirements for thyrotropin suppression in the treatment of differentiated thyroid cancer. J Clin Endocrinol Metab. 1992; 75:344-50. 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