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KMID : 0377519980230010035
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Chung-Ang Journal of Medicine
1998 Volume.23 No. 1 p.35 ~ p.43
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Comparison of T_4 suppressive theraphy with combination therapy in the treatment of benign thyroid nodule
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Choi Seong-Nam
Kong Byoung-Ho
Bae Hyun-Cheol
Oh Yeon-Sahng
Shinn Soon-Hyun
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Abstract
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Traditionally, patients with nontoxic benign thyroid nodule has been treated with levothyroxine. The successful treatment of T4 suppressive therapy, however, has been observed in 50 % of patients with thyroid nodules oven though the treatment were continued more than 1 year. The side effects such as osteoporosis, left ventricular hypertrophy has been observed. Therefore, we performed this study to evaluate the efficacy of the new treatment modality (levothyroxine and methimazole combination) in the treatment of thyroid nodule. Study population was 67 patients having nontoxic benign thyroid nodule. Serum TSH, fT4, T3 and thyroid nodular volume were measured at pretreatment and post-treatment periods. The benign thyroid lesion was confirmed by FNAC (fine needle aspiration cytology). The factors can be influenced on therapeutic response were also studied. The patients were divided into two groups. One group had been treated with levothyroxine only and the other with levothyroxine and anthithyroid drug combination. 47 patients had been treated with levothyroxine only. The other 20 patients had received combination therapy with levothyroxine and methimazole. The mean age and sex ratio, pretreatment nodular volume, TSH, fT4 and total T3 level measured at pretreatment and post-treatment had no stastistical difference between two groups. The combination therapy group had been treated for 8.4 ± 2.6 months and T4 suppressive therapy group for 11.1 ± 4.8 months (P=0.03). Pretreatment TSH concentration was 0.99 ± 0.60 μIU/ml in T4 suppressive therapy group, 1.43 ± 1.21 μIU/ml in combination therapy group. (P=0.023) But the value of serum TSH in both groups was in normal range. The responder group was 17 patients and the response rate was 85 % in combination therapy group and 25 and 53 % in T4 suppressive group. In the combination therapy group, the volume reduction was more greater. (71.5% in combination group, 18.1 % in T4 group) In conclusion, combination therapy can reduce treatment duration, enhance therapeutic response rate for the treatment of benign thyroid nodule. The exact mechanism of methimazole on thyroid nodule wan not not clearly known. Perhapse, the influence of methimazole on the transcription factor may be involved Further study in this regard is needed in the future.
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KEYWORD
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Thyroid nodule, combination therapy, volume reduction
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