Susan J. Mandel, MD; Gregory A. Brent, MD; P. Reed Larsen, MD
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Mandel SJ, Brent GA, Larsen PR. Levothyroxine Therapy. Ann Intern Med. 1994;120:619-620. doi: 10.7326/0003-4819-120-7-199404010-00018
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Published: Ann Intern Med. 1994;120(7):619-620.
We agree that the benefits of levothyroxine therapy for all patients with solitary thyroid nodules have not been clearly established. In one randomized, controlled study, the nodule volume decreased significantly from baseline in those patients receiving levothyroxine but not placebo . Similar results were not achieved in other studies discussed. However, as Dr. Leinung points out, TSH-suppressive therapy may forestall or prevent surgery with its morbidity and cost in selected patients. Because such levothyroxine-responsive nodules cannot be identified by pretreatment variables , we have attempted to devise a rational approach to therapy. To minimize the potential morbidity associated with therapy, we advocate individualizing dosage requirements by using sensitive serum TSH assays, limiting the therapeutic trial period, and withdrawing levothyroxine to establish a causal relation. Levothyroxine therapy for thyroid nodules has also been suggested by others .
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