Changes in Serum Thyroid Hormone, Thyrotropin and Thyroglobulin Concentrations during Thyroxine Therapy in Patients with Solitary Thyroid Nodules

Morita, Terumitsu; Tamai, Hiroshi; Ohshima, Akira; Kobashi, Gén; Matsubayashi, Sunao; Kuma, Kanji; Nakagawa, Etsuya

doi:10.1210/jcem-69-2-227

Cited by 51 publications

(30 citation statements)

References 10 publications

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“…More recently, Morita et al. (14) found a proportion of responders (reduc¬ tion in nodule volume >50%) as high as 36.7% in 49 patients with solitary benign thyroid nodules treated with L-T4 for 3 months. A similar propor¬ tion (42.3%) of responders (decrease in nodule volume^5 0%) has been found by us in 18 patients treated with L-T4 for 4 months (data not shown).…”

Section: Respondersmentioning

confidence: 99%

See 1 more Smart Citation

On the usefulness of levothyroxine suppressive therapy in the medical treatment of benign solitary, solid or predominantly solid, thyroid nodules

Celani

Mariani²,

Mariani³

1990

Acta Endocrinologica

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The efficacy of levothyroxine suppressive therapy in the treatment of benign solitary thyroid nodules is controversial. In order to investigate this issue further we studied 122 patients with a solitary, solid or predominantly solid, thyroid nodule. The benign (colloid) nature of all nodules was proved by fine-needle aspiration biopsy. At the pertechnetate-99m thyroid scanning 91% of the nodules were "cold" and 9% "warm". All the patients received suppressive oral doses of levothyroxine (0.1 to 0.2 mg/day). Fifty-three patients were treated with levothyroxine for 6 months, 31 for 9 months and 38 for 12 months. The size of each nodule before and after treatment was evaluated by high-resolution ultrasonography. The actual suppression of TSH secretion was monitored at 3-month intervals using an ultrasensitive immunometric assay. At the end of levothyroxine treatment, patients were classified as responders (decrease in nodule volume \m=ge\50%,68/122 = 55.7%; mean percent change in nodule volume = \m=-\77.1\ m=+-\ 15.7%), partially responders (decrease in nodule volume <50%, 24/122 = 19.7%; mean percent change in nodule volume = \m=-\27.5\m=+-\10.1%),and nonresponders, when either no change in nodule volume (16/122 = 13.1%) or an increase in nodule volume (14/122 = 11.5%) was observed. In each group serum free T4 rose significantly in response to levothyroxine therapy, whereas serum free T3 remained unchanged. TSH levels were undetectable in all patients. Both the proportion of responders, partially responders and nonresponders, and the mean percent decrease in nodule volume in the responder group were not significantly different in patients treated with levothyroxine for 6, 9 or 12 months, respectively. Therefore, it appears that levothyroxine therapy is effective within 6 months in reducing the size of colloid solitary, solid or predominantly solid, thyroid nodules or in preventing their further growth in about 90% of our patients.Although thyroid suppression is recommended for the medical treatment of benign thyroid nodules (1-3), its efficacy in reducing nodule volume is con¬ troversial. Response rates as high as 61% (4) and as low as 9% (5) have in fact been reported. More recently, Gharib et al. (6) showed that levothyro¬ xine (L-T4) therapy given over a 6-month period did not reduce the size of colloid thyroid nodules despite effective suppression of TSH secretion.In order further to investigate the usefulness of thyroid hormone suppression in the treatment of nodular goitre, we studied the effects on nodule volume of suppressive doses of L-T4 in 122 patients with a colloid solitary, solid or predominantly solid, thyroid nodule. Patients and MethodsThe investigation, which started in November 1988, was conducted in accordance with the principles of the Hel¬ sinki II Declaration. Since the aim of the present study was to investigate the effects of L-T4 therapy on benign (colloid) solitary, solid or predominantly solid (with small cystic spaces =£0.5 cm) thyroid nodules, exclusion criteria included the following:...

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Section: Respondersmentioning

confidence: 99%

“…It is conceivable that differences in the nodule sensitivity to TSH, and therefore to TSH suppression, may exist in different geographic areas, e.g. in the USA (6), in Japan (14), and in Italy. Possibly variations in iodine intake could ex¬ plain some of the differences observed.…”

Section: Respondersmentioning

confidence: 99%

On the usefulness of levothyroxine suppressive therapy in the medical treatment of benign solitary, solid or predominantly solid, thyroid nodules

Celani

Mariani²,

Mariani³

1990

Acta Endocrinologica

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“…An interesting way of improving the risk-benefit ratio of l-T 4 would be to identify a subgroup of patients whose nodules will presumably respond to this drug. Baseline thyroglobulin levels and their decrease during treatment have been advocated as useful predictors of the outcome of l-T 4 therapy (42,43), but we did not study these levels. In fact, in the present study as well as in others (13,14), neither patient nor nodule characteristic was found to be a reliable predictor of nodule shrinkage during l-T 4 treatment, except for pretreatment nodule volume (44).…”

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

126

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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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“…Entretanto, nas hiperplasias e nas neoplasias da glândula, esta dependência é relativa e a produção da Tg nestas situações é, em grande parte, autônoma 11,12 .…”

Section: Discussionunclassified

“…Algumas patologias, contudo, que ocorram no tecido tireoidiano remanescente e que, da mesma forma que as recidivas, produzam Tg independente do TSH como doença de Graves, nódulos hiperplásicos e tireoidite de Hashimoto 11,12 , podem elevar a Tg de níveis acima de 10ng/cc. Estas patologias, contudo, são facilmente diagnosticadas pela clínica e ou pela punção-biopsia com agulha fina (em casos de nódulos palpá-veis) e desta forma descarta recidiva como causa de hipertireoglobulinemia.…”

Section: Discussionunclassified

Valor da dosagem da tireoglobulina no seguimento de pacientes com carcinoma diferenciado da tireóide submetidos à tireoidectomia parcial

Rodrigues

Gonçalves

Ferreira

et al. 2002

Rev. Col. Bras. Cir.

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Recebido em 25/06/2001 Aceito para publicação em 08/10/2001 Trabalho realizado no Hospital Universitário Clementino Fraga Filho da UFRJ. RESUMO: Objetivo:Estudar o valor da dosagem da tireoglobulina (Tg) plasmática na detecção de recidivas, nos pacientes com carcinoma diferenciado da tireóide, submetidos à tireoidectomia parcial. Métodos: São analisados, retrospectivamente, 48 pacientes portadores de carcinoma diferenciado e submetidos à tireoidectomia parcial que foram acompanhados no pós-operatório com dosagens de Tg plasmática. O exame foi realizado no paciente com TSH suprimido (< 0,6mU/cc) e o valor da Tg de 10ng/cc considerado como limite entre os casos com e sem suspeita de recidiva. O tempo médio de seguimento foi de 8,1 anos. Resultados: Onze pacientes apresentaram Tg elevada (> 10ng/cc) e quatro eram portadores de doença benigna capaz de elevar a Tg como hipertireoidismo (dois casos) e doença de Hashimoto (dois casos). Estes quatro pacientes não foram considerados na análise estatística. Os sete restantes foram considerados suspeitos de recidiva tumoral que foi confirmada em seis (verdadeiro positivo) e não confirmada em um (falso positivo). Nos 37 pacientes com Tg baixa (< 10ng/cc) apenas um apresentou recidiva (verdadeiro negativo: 36 e falso negativo: 1). A análise estatística da capacidade da Tg em detectar recidivas mostrou: sensibilidade 85%; especificidade 94%; valor preditivo positivo 85%; valor preditivo negativo 84% e acurácia 95%. Conclusões: Os resultados obtidos neste trabalho mostraram que a dosagem da Tg é de valor na detecção de possibilidade de recidivas no seguimento de pacientes operados por carcinoma diferenciado mesmo quando submetidos à cirurgia parcial.Descritores: Tireoglobulina; Carcinoma diferenciado; Tireoidectomia parcial. 25 INTRODUÇÃOO valor da dosagem da tireoglobulina (Tg) plasmática para detectar recidivas no acompanhamento de pacientes submetidos à tireoidectomia parcial por carcinoma diferenciado é controvertido. Vários autores consideram indispensável a tireoidectomia total para valorizar o exame, argumentando que a persistência de tecido tireoidiano nas ressecções parciais pode ser os responsável por eventual elevação da Tg plasmática, mesmo na ausência de recidivas 1-6 . Outros autores, contudo, valorizam o método mesmo sem tireoidectomia total, desde que realizado após supressão do TSH hipofisário pela administração prévia de hormônio tireoidiano 7,8 .Neste trabalho, apresentamos nossa experiência com a dosagem da Tg no seguimento pós-operatório de pacientes submetidos à tireoidectomia parcial no tratamento do carcinoma diferenciado no Serviço de Cirurgia Geral do Hospital Universitário Clementino Fraga Filho. MÉTODOSForam analisados 48 pacientes submetidos à tireoidectomia parcial e acompanhados com dosagens da Tg

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Changes in Serum Thyroid Hormone, Thyrotropin and Thyroglobulin Concentrations during Thyroxine Therapy in Patients with Solitary Thyroid Nodules

Cited by 51 publications

References 10 publications

On the usefulness of levothyroxine suppressive therapy in the medical treatment of benign solitary, solid or predominantly solid, thyroid nodules

On the usefulness of levothyroxine suppressive therapy in the medical treatment of benign solitary, solid or predominantly solid, thyroid nodules

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

Valor da dosagem da tireoglobulina no seguimento de pacientes com carcinoma diferenciado da tireóide submetidos à tireoidectomia parcial

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