Treatment of Nontoxic Goiter with Sodium Liothyronine

Badillo, J M; Shimaoka, Katsutaro; Lessmann, Ellen M.; Marchetta, Frank C.; Sokal, Joseph E.

doi:10.1001/jama.1963.03700140085012

Cited by 31 publications

(6 citation statements)

References 9 publications

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“…Improved safety has been obtained in the latest years following the wide diffusion of sensitive TSH assays, and the corresponding reduction in LT4 dose [38, 50]. We are not aware of controlled studies comparing the efficacy of various degrees of TSH reduction on the course of the nodular thyroid disease; however, the dose reduction seems not to correspond to a decrease in the percentage of response to the treatment [3, 51‐53]. In our series, the therapeutic efficacy of nonsuppressive doses of LT4 was evaluated by means of a retrospective analysis of nodule size both in treated and untreated groups; our results are similar to the data reported using suppressive doses of LT4 [2].…”

Section: Discussionmentioning

confidence: 99%

Treatment of benign nodular goitre with mildly suppressive doses of L‐thyroxine: effects on bone mineral density and on nodule size

Baldini

Gallazzi

Orsatti

et al. 2002

Journal of Internal Medicine

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Objectives. To evaluate (i) the demineralizing effect of L-thyroxine (LT4) therapy at doses mildly inhibiting serum thyroid stimulating hormone (TSH) in patients with benign nodular goitre; (ii) the efficacy of treatment on nodule size. Design. Cross-sectional study comparing euthyroid women with nodular goitre treated with LT4 for ‡ 2 years (52 ± 32 months, range 24-138, median 42) and a matched group with untreated goitre. Subjects. A total of 89 female outpatients (53.3 ± 9 years; 36 pre-and 53 postmenopausal), 43 treated and 46 untreated. Main outcome measures. Bone mineralization was measured with total body and regional mineralometry [dual energy X-ray absorptiometry (DEXA)], and indirectly evaluated with biochemical parameters (alkaline phosphatase, osteocalcin). Efficacy of LT4 therapy was assessed by measuring the nodule size during ultrasonography. The adequacy of the treatment was evaluated on the basis of serum TSH levels. Results. No significant differences were found at DEXA for total body and regional mineralization (P > 0.05 for all comparisons) in treated and untreated patients, both in pre-and postmenopausal states. Evaluation of the nodule size during the ultrasound scan showed a reduction of ‡ 30% in 11 of 43 treated patients (26%) versus none of the untreated, an unchanged size in 29 treated patients (67%) versus 18 untreated, an increase of nodules and/or new nodule development in three treated patients (7%) versus 28 untreated (61%). Conclusions. L-thyroxine (LT4) treatment at doses slightly suppressing TSH does not significantly affect bone mineralization, nor does it represent a risk factor for osteoporosis, even in postmenopausal patients. The efficacy of this therapeutic schedule on goitre size is comparable with the effects previously reported with suppressive doses.

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Section: Discussionmentioning

confidence: 99%

Treatment of benign nodular goitre with mildly suppressive doses of L‐thyroxine: effects on bone mineral density and on nodule size

Baldini

Gallazzi

Orsatti

et al. 2002

Journal of Internal Medicine

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“…The benefit of suppressive treatment of the goiter with thyroid hormones observed in 1953 [Greer and Astwood, 1953] and con firmed later by many authors in humans [Schneeberg et al, 1962;Badillo et al, 1963;Shimaoka and Sokal, 1975] and rats [Islambekov et al, 1975] was attributed to contin uous TSH suppression.…”

Section: Introductionmentioning

confidence: 76%

Increased Thyroidal T<sub>4</sub>/T<sub>3</sub> Ratio in Nodular and Paranodular Tissues of Nontoxic Goiter following Suppressive Treatment with Thyroid Hormones

Solter¹,

Tišlarić²,

Pegan

et al. 1987

Horm Res

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The effect of suppressive treatment with thyroid hormones on thyroidal iodothyronines and T₄/T₃ ratio in nodular and paranodular tissues was investigated in 12 patients with nontoxic goiter. Results were compared to those from 11 nontreated patients. Continuous thyroid hormone administration produced a significant increase in thyroidal T₄and T₄/T₃ ratio in nodular tissues while T₃ remained unchanged. In paranodular tissues a significant rise of T₄/T₃ ratio, an insignificant increase in T₄ and a decrease in T₃ were observed following the administration of thyroid hormones. The results are very similar to those obtained in paranodular tissue of autonomously functioning thyroid nodule, and are probably the consequence of suppressed TSH secretion, as TSH predominantly stimulates the synthesis of T₃ and/or thyroidal T₄ monodeiodination.

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“…The effect of l-T 4 treatment on thyroid nodule volume has been extensively studied. However, except for one study published in 1963 (27), the results of which are questionable because of inappropriate methodology (21), only eight trials were randomized (Table 5; Refs. 11, 13, 14, 19, 20, 28 -30).…”

Section: Discussionmentioning

confidence: 99%

Effects of Thyroid-Stimulating 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

Wémeau¹,

Caron²,

Schvartz³

et al. 2002

The Journal of Clinical Endocrinology & Metabolism

127

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The efficacy of suppressing TSH secretion with levothyroxine (L-T(4)) in reducing solitary thyroid nodule growth is still controversial. In this prospective multicenter, randomized, double-blind, placebo-controlled trial, 123 patients with a single palpable benign nodule were included and randomly allocated to an 18-month treatment with L-T(4) or placebo. Individual dose was adjusted to allow a serum TSH level below 0.3 mIU/liter. Clinical and ultrasonographic nodule characteristics were assessed before treatment and 3, 6, 12, and 18 months thereafter. The largest mean nodule size assessed on palpation and largest volume, assessed by ultrasonography, decreased in the L-T(4) group and increased slightly in the placebo group [size, -3.5 +/- 7 mm vs. +0.5 +/- 6 mm (P = 0.006); volume, -0.36 +/- 1.71 ml vs. +0.62 +/- 3.67 ml (P = 0.01), respectively]. The proportion of clinically relevant volume reduction (> or =50%) rose significantly in the L-T(4) group [26.6% vs. 16.9% (P = 0.04)]. The proportion of patients with a reduced number of infraclinical additional nodules was significantly higher in the L-T(4) group [9.4% vs. 0 (P = 0.04)]. It is concluded from this study that suppressive L-T(4) therapy is effective in reducing solitary thyroid nodule volume and improving infraclinical extranodular changes.

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Treatment of Nontoxic Goiter with Sodium Liothyronine

Cited by 31 publications

References 9 publications

Treatment of benign nodular goitre with mildly suppressive doses of L‐thyroxine: effects on bone mineral density and on nodule size

Treatment of benign nodular goitre with mildly suppressive doses of L‐thyroxine: effects on bone mineral density and on nodule size

Increased Thyroidal T<sub>4</sub>/T<sub>3</sub> Ratio in Nodular and Paranodular Tissues of Nontoxic Goiter following Suppressive Treatment with Thyroid Hormones

Effects of Thyroid-Stimulating 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

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