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Levothyroxine Therapy
- Susan J. Mandel, MD;
- Gregory A. Brent, MD; and
- P. Reed Larsen, MD
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IN RESPONSE:
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 [1]. 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 [2], 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 [3].
As noted by Dr. Liel, because activated charcoal does reduce levothyroxine absorption, its use has been recommended in the treatment of thyroid hormone overdosage [4]. We agree that the lovastatin-levothyroxine interaction is still tenuous. For this reason, lovastatin was listed in our Table 2 as a drug that “possibly” blocks levothyroxine absorption. We also wish to call to readers' attention a recent report that sodium polystyrene sulphonate (Kayexalate; Sanofi Winthrop Pharmaceuticals, New York, New York) also interferes with intestinal absorption of levothyroxine [5] and may increase levothyroxine requirements.
Susan J. Mandel, MD
Gregory A. Brent, MD
P. Reed Larsen, MD
Harvard Medical School; Brigham and Women's Hospital; 75 Francis Street; Boston, MA 02115
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.
- Copyright ©2004 by the American College of Physicians
