LEVOTHYROXINE AND POTASSIUM-IODIDE ARE BOTH EFFECTIVE IN TREATING BENIGN SOLITARY SOLID COLD NODULES OF THE THYROID

Objective: To determine the effectiveness of levothyroxine and potassi um iodide in treating patients with benign solitary cold thyroid nodul es. Design: Randomized controlled study. Setting: Outpatient clinic at a university hospital. Patients: 80 patients with solitary solid cold thyroid nodules found to be benign at cytologic examination were rand omly assigned to no treatment, suppressive levothyroxine (thyroid-stim ulating hormone level, < 0.3 mU/L), or low-dose potassium iodide (2 mg every 2 weeks). Seventy patients completed the 1-year study. After 1 year, patients receiving treatment discontinued drug therapy and were re-evaluated 4 months later; patients receiving no treatment were give n levothyroxine and were followed for a second year. Measurements: Nod ule volume was measured by ultrasonography at 4-month intervals by an observer masked to treatment assignment. Results: Mean nodule volume d ecreased by 40% of the basal volume in the 23 patients receiving levot hyroxine (P < 0.001) and by 23% of the basat volume in the 25 patients receiving potassium iodide (P = 0.053). Volume slightly increased in the 22 untreated patients (P = 0.085). A clinically relevant reduction in nodule volume (greater than or equal to 50%) was observed in 9 of 23 patients treated with levothyroxine, in 5 of 25 patients treated wi th potassium iodide, and in none of 22 untreated patients (P = 0.004). Only nodules with a volume of 10 mt or less were reduced; nodules wit h Volumes of 5 mL or less shrank most frequently. Nodule Volume did no t relevantly increase in treated patients but did increase in 3 of the 22 untreated patients. Drug withdrawal resulted in an increased mean nodule volume (P = 0.004) after 4 months. Conclusions: Levothyroxine a nd, to a lesser extent, potassium iodide are effective in arresting th e growth or in reducing the volume of benign solitary solid cold thyro id nodules, especially small ones; discontinuation of therapy may resu lt in resumed nodule growth.