The quality of evidence is downgraded by study limitations (lack of blinding).
A Cochrane review [Abstract] 1 included 31 studies with a total of 2952 outpatients to investigate the effects of different therapies on benign thyroid nodules. Studies on levothyroxine therapy (LT4), percutaneous ethanol injection (PEI), laser photocoagulation (LP) and radiofrequency (RF) ablation therapy randomised 2083, 607, 192 and 70 participants, respectively. The duration of treatment varied according to the applied therapies: up to five years for LT4 and one to three for PEI ablations, one to three for LP sessions and one or two for RF sessions. Median follow-up was 12 months for LT4 and six months for minimally invasive therapies.
LT4 compared with no treatment or placebo was associated with a nodule volume reduction of 50% or more in 16% compared with 10% of participants after 6 to 24 months of follow-up (RR 1.57; 95% CI 1.04 to 2.38; 958 participants, 10 studies, Table 1). Pressure symptoms or cosmetic complaints were not investigated in LT4 studies. LT4 therapy was generally well tolerated: 3 studies provided quantitative data on signs and symptoms of hyperthyroidism, which were observed in 25% of LT4-treated versus 7% of placebo-treated participants at 12 to 18 months of follow-up (269 participants, 3 trials).
| Outcome | Effect size | Control | Intervention | No. of patients (studies) |
|---|---|---|---|---|
| Nodule volume reduction ≥ 50% | RR 1.57 (1.04 to 2.38) | 98 of 1000 | 154 of 1000(102 to 233) | 958 (10) |
A study published in July 20142 addressed the efficacy of non-suppressive L-T4 treatment in benign nodular goiter compared to no treatment. 356 female patients in the age range 19-45 at study entry (201 untreated and 165 treated with a non-suppressive LT4 dose) were followed for 1-9 years. The volume of thyroid nodules was determined by ultrasonography. The growth of benign thyroid nodules was inversely correlated to their size and treatment with LT4 at a non-TSH-suppressive dose significantly reduced their growth (mean initial volume in control and treatment group was 3.91 ± 6.87 and 4.01 ± 7.35 ml, respectively; final volume was 5.37 ± 8.49 and 4.39 ± 6.72 ml, respectively).
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