Thyroid hormone suppressive therapy for thyroid nodules and benign goiter
- Douglas S Ross, MD
Douglas S Ross, MD
- Section Editor — Thyroid Disease
- Professor of Medicine
- Harvard Medical School
The efficacy of thyroid hormone suppressive therapy in euthyroid patients with solitary benign thyroid nodules or sporadic nontoxic multinodular goiters is controversial. Most studies have shown that few thyroid nodules regress in patients taking thyroid hormone. However, suppressive therapy does appear to interfere with goitrogenesis in many patients, and it has been proposed that it could reduce the risk of thyroid oncogenesis, as well. The American Thyroid Association (ATA) does not recommend suppression therapy of benign thyroid nodules in iodine sufficient populations .
This topic will review potential benefits and risks of thyroid hormone suppressive therapy in patients with benign nodules or goiter. The overall approach to the evaluation and treatment of patients with goiter and with thyroid nodules, as well as the use of thyroid hormone suppressive therapy in thyroid cancer, is discussed separately. (See "Clinical presentation and evaluation of goiter in adults" and "Diagnostic approach to and treatment of thyroid nodules" and "Differentiated thyroid cancer: Overview of management", section on 'Thyroid hormone suppression'.)
Suppression of thyroid-stimulating hormone (TSH) secretion in normal subjects by the administration of thyroid hormone results in thyroid atrophy . Although the pathogenesis of thyroid nodules and sporadic nontoxic multinodular goiters is poorly understood, 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 or goiter size or at least prevent further enlargement.
The importance of TSH in goiter formation varies with the cause of the goiter. For example, in patients with iodine deficiency or chronic autoimmune (Hashimoto's) thyroiditis, an increase in TSH secretion is the predominant cause of goiter. In contrast, most patients with thyroid nodules or sporadic nontoxic multinodular goiters have normal serum TSH concentrations. In them, particularly those with nontoxic multinodular goiters, the thyroid enlargement is probably caused by several growth factors (including TSH) that act over time on thyroid follicular cells that have different synthetic and growth potentials. The result is diffuse and later multinodular thyroid enlargement; some nodules eventually become autonomous , and others may undergo cystic degeneration.
Because thyroid hormone is presumed to reduce goiter size by reducing TSH secretion, suppressive therapy would be expected to be ineffective in patients in whom serum TSH concentrations were already subnormal due to autonomous thyroid hormone production.
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