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Levothyroxine Therapy
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
I take exception to the outdated recommendation in the otherwise excellent review of thyroid hormone use [1] for using levothyroxine to temporarily suppress solitary, nonfunctioning, benign nodules [2, 3]. The authors admit that randomized, controlled trials do not show any benefit of levothyroxine use over placebo in shrinking nodules. What, then, is being accomplished? Because thyroid cancers respond to levothyroxine therapy, those whose nodules shrink, still require observation and possible repeat biopsy [2]. Surgery is generally recommended if the nodule grows, whether or not the patient is receiving levothyroxine. If the size of the nodule remains unchanged, management is the same, regardless of suppressive therapy (that is, observation and perhaps future repeat biopsy). Thus, patient management is essentially unchanged. Furthermore, no data indicate a better outcome (fewer thyroidectomies or a lower rate of malignant transformation) with suppressive therapy.
One potential indication for suppressive therapy is when surgical removal is being considered for size alone because shrinkage of the nodule might prevent surgery. Short-term levothyroxine therapy may not always be benign [4], and the potential benefits must outweigh the risk.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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