Role of levothyroxine suppressive therapy for benign cold nodules of thyroid: a randomized, double-blind, placebo-controlled clinical trial

Larijani, Bagher; Pajouhi, Mohammad; Bastanhagh, Mohammad Hasan; Sadjadi, Alireza; Aghakhani, Shahriar; Zare, Fateme; Sedighi, N; Eshraghian, Mohammad Reza; Nadjafi, Amir Hossein; Amini, Mohammad Reza; Adibi, Hos­sein; Akrami, Seyed Mohammad

doi:10.2217/14750708.2.6.883

Cited by 4 publications

(2 citation statements)

References 31 publications

(33 reference statements)

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“…A nyitott műtétnek számtalan hátulütője lehet, úgy-mint a hosszas kórházi benntartózkodás, a nehezen elfedhető nyaki heg, a nervus recurrens sérülése, de itt említhető az esetleges későbbi reoperálási nehézség is. A levothyroxin szuppressziós kezelés eredményei -mint a műtét alternatívája -mind a mai napig ellentmondáso-sak [20], alkalmazása háttérbe szorult. A fentieket figyelembe véve érthető a minimálisan invazív kezelési mód-szerek térnyerése.…”

Section: áLtalános Megfontolásokunclassified

Thermoablatiós lehetőségek a benignus térfoglaló képletek gyógyításában

2016

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Bevezetés: Bizonyos jóindulatú tumorok méretükből és elhelyezkedésükből fakadóan tartós diszkomfort érzést, súlyo-sabb esetben rupturálva végzetes kimenetelű vérzést is okozhatnak. Megoldásként eddig a daganatok obszervációja, indokolt esetben a sebészeti beavatkozás, válogatott esetekben pedig a transarterialis embolisatio adódott. Célkitűzés: Célkitűzésünk az volt, hogy ismertessük a jóindulatú elváltozások thermoablatiós kezelési lehetőségeit. Módszer: A Semmelweis Egyetem Transzplantációs és Sebészeti Klinikáján kezelt négy betegen végzett beavatkozásokat ismertetjük. Egy esetben pajzsmirigy-adenoma, egyben vese-angiomyolipoma kezelése történt rádiófrekvenciás készülék-kel, két betegnél pedig májhaemangioma-ablatióra került sor mikrohullámú antenna segítségével. Eredmények: A kezelés minden esetben szövődménymentesnek bizonyult, a kontrollvizsgálatoknál a legtöbb elváltozás mérete csökkent. Az átlagos volumencsökkenés 32,7% volt. A kezelés hatására az elváltozások kontrasztanyag-halmozása is csökkent. A halmozást mutató tumortérfogat-csökkenés átlagosan 75,3% volt. Következtetések: A thermoablatiós módszerek a fent említett benignus szöveti természetű daganatok esetében biztonsággal alkalmazhatók, az eljárás technikájából fakadóan kiváló kozmetikai eredménnyel, rövidebb kórházi benntartózkodással és lábadozási idővel járnak. Orv. Hetil., 2016, 157(51), 2040-2047. Kulcsszavak: intervenciós radiológia, ablatio, benignus tumor Thermoablation therapy in the treatment of benign lesionsIntroduction: Depending on their size and location, some benign tumors can cause prolonged discomfort and even rupture and fatal bleeding in severe cases. Hitherto the therapeutic strategies for such lesions were observation, surgery and in selected cases transarterial embolization. Aim: Our aim was to present the possibilities of thermoablation for treating lesions. Method: Here we present interventions of four patients in Semmelweis University Department of Transplantation and Surgery. A thyroid adenoma and a kidney angiomyolipoma were treated with radiofrequency ablation. Two patients with a liver haemangioma were treated with microwave thermoablation technique. Results: Complications were not observed in any of the cases. In most cases, the size of the treated lesions decreased. The mean decrease in volume was 32.7%. The contrast enhancement of the lesions also decreased, the mean reduction in contrast enhancing volume was 75.3%. Conclusions: Thermoablational procedures for the benign tumors presented above are safe. The therapy shows excellent cosmetic results, a shorter hospital stay and quicker recovery.

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Section: áLtalános Megfontolásokunclassified

Thermoablatiós lehetőségek a benignus térfoglaló képletek gyógyításában

2016

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“…Of 19 studies identified, data from 11 were included 3,[7][8][9][10][11][12][13][14][15][16] and eight studies were excluded. Of these eight, we sent a request for data to the authors of three studies [17][18][19] as the data in the papers were insufficient to decide how many people failed in either one or both treatment groups.…”

Section: Quantitative Synthesismentioning

confidence: 99%

Thyroxine Suppression Therapy For Benign, Non-Functioning Solitary Thyroid Nodules: A Quality-Effects Meta-Analysis

Yousef

Clark

Doi

2010

Clinical Medicine & Research

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Levothyroxine (LT4) suppressive therapy for solitary thyroid nodules is not popularly advocated presently because its clinical efficacy and safety are currently considered controversial. This metaanalysis aims to address efficacy issues by using rigorous methods to arrive at a pooled estimate. On the basis of the analysis, it is estimated that LT4 therapy is clearly associated with up to a two-fold increase in the chance of nodule reduction. This translates to a number needed to treat (NNT) of 6 or a 50% decrease in the risk of cancer given nodule reduction. Keeping this definition of efficacy in mind and a low incidence of adverse events with low level LT4 suppression, such an intervention might be appropriate in patients selected on the basis of a low risk for adverse effects. The natural history of thyroid nodules suggests that a third of benign nodules will spontaneously grow to more than 15% of its initial size within one year and this increases to almost all (89%) at five years if these nodules are not treated somehow. 1 The majority of growth has been found in those nodules that have a more solid component. Although the pathogenesis of such growth is poorly understood, thyroid-stimulating hormone (TSH) is presumed to be necessary if not sufficient, and therefore suppression of TSH secretion might be expected to result in a decrease in nodule size or at least prevent any further enlargement.Benign solitary nodules detected by physical examination represent two different pathological processes. In many of these patients, the palpated nodule could simply be the dominant nodule of a multinodular goiter while other solitary nodules are probably true solitary adenomas. The latter can be distinguished by ultrasound and nonrandomized, uncontrolled trials have found that patients with solitary nodules had lesser decreases in nodule size in response to thyroxine therapy than patients with nontoxic diffuse or multinodular goiters.2 Of the randomized trials that have been published, the majority demonstrated some degree of efficacy of thyroxine therapy for solitary thyroid nodules. Meta-analyses of these trials was first attempted in 1998 and showed a reduction in thyroid solitary nodule volume in 17% of patients treated with levothyroxine and inhibition of nodule growth in another 10%.3 A second meta-analysis found that nodules decreased by more than 50% in more patients who received thyroxine therapy, but the treatment response did not reach statistical significance (relative risk [RR] 1.9; 95% confidence interval [CI] 0.9 to 3.8).4 Also, there have been concerns about subclinical hyperthyroidism in treated patients who may be at increased risk for atrial

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Levothyroxine or minimally invasive therapies for benign thyroid nodules

Bandeira‐Echtler

Bergerhoff

Richter

2014

Cochrane Database of Systematic Reviews

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No study evaluated all-cause mortality, health-related quality of life or provided systematic data on the development of thyroid cancer. Longest follow-up was five years and median follow-up was 12 months. Nodule volume reductions were achieved by PEI, LP and RF, and to a lesser extent, by LT4. However, the clinical relevance of this outcome measure is doubtful. PEI, LP and RF led to improvements in pressure symptoms and cosmetic complaints. Adverse events such as light-to-moderate periprocedural pain were seen after PEI, LP and RF. Future studies should focus on patient-important outcome measures, especially health-related quality of life, and compare minimally invasive procedures with surgery. RCTs with follow-up periods of several years and good-quality observational studies are needed to provide evidence on the development of thyroid cancer, all-cause mortality and long-term adverse events.

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Role of levothyroxine suppressive therapy for benign cold nodules of thyroid: a randomized, double-blind, placebo-controlled clinical trial

Cited by 4 publications

References 31 publications

Thermoablatiós lehetőségek a benignus térfoglaló képletek gyógyításában

Thermoablatiós lehetőségek a benignus térfoglaló képletek gyógyításában

Thyroxine Suppression Therapy For Benign, Non-Functioning Solitary Thyroid Nodules: A Quality-Effects Meta-Analysis

Levothyroxine or minimally invasive therapies for benign thyroid nodules

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