Levothyroxine therapy in preventing nodular recurrence after hemithyroidectomy: A retrospective study

Aim: To determine the effect of levothyroxine (L-T(4)) therapy on the recurrence rate of nodular disease in patients previously treated with lobectomy for benign nodular goiter. Methods: Two hundred and thirty-tree patients (38 males, 195 females; age 49.9 +/- 13.1 yr) with no post-surgical evidence of nodular disease in the remnant, were followed-up yearly with serum TSH and ultrasound (US). Nodular recurrence was defined as a lesion of at least 5 mm at US. Patients were divided in 2 groups based on whether or not they had been treated with L-T(4) after surgery: Group 1 (45 patients) who did not receive any L-T(4), and Group 2 (188 patients) treated with L-T(4). Group 2 was further subdivided in Group 2a (123 patients) receiving L-T(4) substitutive therapy (TSH >= 0.5 and <= 3 mUl/l) and Group 2b (65 patients) receiving L-T(4) at TSH-suppressive dose (TSH<0.5 mUl/l). Results: Mean observation period was 5.8 +/- 4.7 yr. Overall, 71 out of 233 (30.5%) patients experienced recurrence of thyroid nodular disease: 29 patients (64.4%) in Group 1, 24 (19.5%) patients in Group 2a, and 18 (27.7%) patients in Group 2b. The recurrence rate was significantly lower (p<0.001) in Group 2 compared with Group 1, but no significant difference was observed between Groups 2a and 2b. Conclusion: In patients who have undergone hemithyroidectomy for benign monolobar nodular disease, L-T(4) therapy may prevent recurrence of nodular disease. TSH suppression may not be required for prevention of recurrence in the remnant thyroid tissue. (J. Endocrinol. Invest. 32: 330-334, 2009) (C)2009, Editrice Kurtis