[Medical Treatment of Thyroid Nodule]

Whereas in regions with sufficient iodide intake treatment of thyroid nodules with levothyroxine has been almost completely abandoned and is also not further recommended by guidelines, medical treatment may be still indicated in Germany as recently demonstrated by randomized, placebo-controlled LISA study.A major reason for this is mild iodide deficiency in patients with thyroid nodules. In LISA study a combined therapy of levothyroxine and iodide resulted in an at least 50 % reduction of nodular volume in 21,6 % of treated patient compared to in only 5,2 % of placebo-treated patients.To avoid TSH suppression levothyroxine dose must be adjusted that TSH is in the lower reference range, since subclinical hyperthyroidism may result in cardiac adverse events as arrythmias.In the elderly the cardiac risk has to be considered and levothyroxine dose has frequently to be reduced or therapy even to be stopped.