Suppressive therapy with thyroxine is an option for decreasing thyroid size in euthyroid goiter, but this therapy remains controversial. One placebo-controlled trial of thyroid suppression in nontoxic multinodular goiter showed regression of thyroid size with suppressive therapy (58% reduction in size in treatment group vs 5% reduction in control group). However, not all goiters responded to this therapy, and the thyroid size returned to pretreatment size within 9 months of discontinuation of suppressive therapy.5
Many experts argue against the use of suppressive therapy in long-standing goiters, citing less response from these patients, along with concern about side effects and possible oversuppression, but the evidence in this area is limited. Patients who are treated with thyroxine should be followed for possible side effects of the medication, including arrhythmia and osteopenia, particularly in elderly patients and those who take the medication for long periods.
Recommendations of others
Guidelines from the American Association of Clinical Endocrinology’s Task Force on Thyroid Nodules, released in 2006, recommends ultrasound be used routinely in the case of multinodular goiter to assist with diagnosis, detect suspicious nodules that may require biopsy, and to serve as an objective baseline measure. This group recommends against use of suppression therapy in long-standing goiters.6