THE EFFECTIVENESS OF LEVOTHYROXINE SUPPRESSIVE THERAPY IN PATIENTS WITH MULTINODULAR GOITER
ERGÜN ERDEM, BİROL BOSTANCI, AKIN ÖZDEN, UĞUR SUNGURTEKİN, MEHMET NEŞŞAR
Pamukkale Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı, DENİZLİ
The use of thyroid hormone for suppression therapy of multinodular goiter is controversial. The aim of this study is to evaluate the efficacy of levothyroxine suppression therapy in patients with multinodular goiter.
Ninety-five patients with multinodular goiter treated between September 1994and December 1996 were prospectively evaluated. The patients were divided into two groups. Group 1 consisted of fifty-three patients and the patients in this group did not receive levothyroxine supperssion therapy. There were forty-two patients in group II and the patients in this group received levothyroxine, 100 mgr per day. The baseline serum TSH levels were kept between 0.1-0.5 mU/L range during the supression therapy. Ultrasonography was used to measure the diameter of the dominant thyroid nodules before and after therapy. The length of follow-up was 12 months.
After 1 year of follow-up, statistically significant difference in the reduction rate of the diameter of dominant nodules was demonstrated between the two groups (p<0.01). However there were no statistically significant difference in increment of diameter or overall alteration of the nodules between the two groups (p>0.05). Subclinical hyperthyroidis was detected in six of the patients in the group which received supression therapy.
In conclusion, in spite of the demonstration of significant nodule diameter reduction, we do not advocate thyroid hormone suppression therapy in patients with multinodular goiter, because there were no significant difference in increment of diameter or overall alteration of the nodules, and because of the potential disadvantages such as obligation of long-term usage and subclinical hyperthyroidism, especially in old and postmenopausal patients.
Keywords: MULTINODULAR GOITER, LEVOTHYROXINE, SUPPRESSION