Levothyroxine Treatment in Pediatric Benign Thyroid Nodules

Abstract

Aim: To evaluate the effectiveness of levothyroxine therapy in benign thyroid nodules in pediatrics. Methods: Data from 78 euthyroid children and adolescents with benign thyroid nodules were retrospectively collected. Subjects were divided into 2 groups: levothyroxine treated (n = 36) and nontreated (n = 42), and the clinical, laboratory and sonographic features of the 2 groups were compared. Nodules were considered benign according to histology, fine-needle aspiration biopsy or by features suggestive for benignity. The groups were followed up for 2.4 ± 1.3 years, and treated patients received a mean dose of levothyroxine of 1.69 ± 0.66 µg/kg/day. Results: Patients in the treated and nontreated groups were comparable for age, sex and follow-up. A reduction in nodule diameter from 2.24 ± 0.94 to 1.86 ± 1.17 cm (p = 0.039) was observed in treated patients, whereas the nodule diameter increased from 1.66 ± 0.86 to 1.78 ± 0.91 cm in nontreated patients (p = 0.024). In the treatment group, 11 patients (30.6%) had a reduction greater than 50% and significantly decreased palpable nodules (p < 0.001). A nonsignificant reduction in reported symptoms was observed, too. The change in nodule size was directly correlated with thyroid-stimulating hormone levels (r = 0.640, p < 0.001) and inversely with levothyroxine dose (r = –0.389, p = 0.009). In nontreated subjects, both palpable nodules and symptoms increased. Conclusion: This study supports levothyroxine treatment effectiveness in shrinking benign nodules.

Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer

“…About a third (30.6%) of euthyroid children had a ‡ 50% reduction in nodule size, which was directly correlated with TSH levels (r = 0.640, p < 0.001) and inversely with LT 4 dose (r = -0.389, p = 0.009) (140).…”

“…Levothyroxine (LT 4 ) suppression therapy has been evaluated for its efficacy to reduce nodule size or to reduce the risk of subsequent nodule formation. However, there are only minimal data regarding long-term safety and potential side-effects of LT 4 therapy (140,141).…”

Predictors of Malignancy in Children with Thyroid Nodules

“…On the other hand, benign nodules remained unmodified or decreased in size in more than 75% of cases. This has relevance in considering the role of TSH in promoting nodule growth and in the natural history and treatment of hyperthyrotropinemia in childhood thyroid cancer, 8,23,[36][37][38][39] factors deserving further investigations. It should be emphasized that there are no current indications for medical therapy in thyroid nodule treatment, and our study is not designed to provide them.…”

Subhyoid ectopic thyroid with a solitary colloid nodule in a 10-year-old girl: a rare diagnostic entity

“…In fact, as seen here, an increase in nodule size during ultrasound followup, particularly during a trial with suppressive levothyroxine therapy has also been advocated as an index of malignancy. 8,9 For the category of children who have a benign cytopathology, surgery may be considered due to increasing size, compressive symptoms, cosmetic reasons or patient's choice. 10 …”