I have a question I'm sure you've been asked many times. During my annual check up my Dr. found a lump on the left side of my throat. I was sent for an ultrasound which determined a solid lump. At which time I was sent for a biopsy which turned out to be non-cancerous. However to shrink the lump he put me on Synthroid starting with 50mgs and now almost six months later I've been bumped up to 100mgs because he says the TSH levels are coming down like he'd like them to be. I have read and heard numerous references that medication does not shrink thyroid lumps. Is there any thruth to this and am I just wasting my time by taking Synthroid. I am starting to have some side affects from Synthroid and starting to feeling bad. Just for the record my Thyroid levels were normal when the lump was discovered. Also if the medicine doesn't work what is normally the next step? I am 43, two children and have Fiber Cyst disease in the breasts.
The current American Thyroid Association guidelines do not recommend routine TSH suppression for nodules - if the baseline labs are normal we usually don't use meds -- but if we use meds we need to keep the TSH from being over-suppressed ( <0.2 ) to avoid heart rhythm problems and bone loss. Usually the nodules don't shrink but in some patients, it may help prevent growth.
From what I have read, there is very little medical evidences which agree that treatment will shrink the lump, and, its not the med. per se but TSH suppression.
Normally, doctors will take the wait and see approach when the FNA shows
non-cancerous and all else is ruled out. Meaning doctor will monitor the lump to see if it grows and how fast. If there has been too much damage done to the thyroid, nodules will not disappear, they will show some evidence. If it grows fast and/or large, surgery is normally the treatment option. I would discuss your concerns with your doctor, for your doctor might have reasons for the approach taken, in which you might not be aware of. Also let him know that you are not feeling well with the treatment.
Sonographically guided percutaneous ethanol injection (PEI) has been recently used with excellent results in the treatment of toxic and pretoxic thyroid adenoma. The aim of the present study was to assess the efficacy of PEI also in the treatment of "cold" thyroid nodules. Twenty patients, each with a single thyroid nodule, underwent PEI. In all cases the nodules were found to be cold by thyroid scintiscan. A total of 16.1 mL +/- 3.1 mL of ethanol was injected once a week. No adverse effects were observed during therapy. A striking nodular shrinkage was obtained in all cases, ranging from 72.8% to 97.6% (mean 84.5%, p < 0.001 vs pretreatment volume). These preliminary results suggest that PEI is an effective and safe therapy that may be useful in the treatment of thyroid nodules as an alternative to other therapies (surgery, L-thyroxine).
Percutaneous Ethanol Injection
Approximately 10 years ago, percutaneous ethanol injection (PEI) was proposed as an alternative to RAI for the treatment of solitary, autonomous thyroid nodules. Since then, PEI has also been used to treat nonfunctioning solid and cystic nodules.[67,68,69,70,71,72,73,74] Injection of 95% ethanol produces nodule shrinkage secondary to coagulative necrosis and thrombosis of small intranodular blood vessels. An experienced operator must perform PEI; multiple injections are often necessary to achieve complete ablation, and adverse effects are not uncommon (pain, ethanol seepage outside the nodule, and rarer events, such as transient thyrotoxicosis and recurrent laryngeal nerve damage).
The vast majority of data published on PEI of thyroid nodules come from noncontrolled trials. In the multicenter study cited above, 429 patients with toxic or autonomously functioning thyroid nodules were treated with PEI (2–12 sessions). At the 12-month follow-up, normalization of both TSH levels and scintiscan findings was documented in almost all patients whose nodule volumes were initially less than 15 ml. A few years later, Zingrillo et al. retrospectively analyzed the effects of PEI and RAI in two groups of patients with large, toxic nodules (3–4 cm in diameter). After a median follow-up of 36 months, outcomes in the two groups were similar in terms of nodule shrinkage and normalization of serum TSH.
In a randomized trial comparing PEI and TSH-suppressive doses of levothyroxine, significantly greater nodule shrinkage 12 months after treatment was found in the 25 patients treated with PEI (reductions of 47% with PEI versus 9% with levothyroxine). The same authors later compared two groups of 30 patients who had small, solid nodules (mean volumes 9.9 ml and 9.4 ml, respectively). The first group was treated with a single PEI whereas three injections were administered in the second group. At the 6-month follow-up, the overall reduction in nodule volume was 51%, and there were no significant differences between the two groups.
The best results have been obtained in the treatment of large or symptomatic cystic nodules.[67,68,70] In a prospective study with a mean follow-up of 5 years, nodule-volume reductions of over 50% were achieved in 40 of 43 patients with cystic nodules (mean volume 38.4 ml) treated by PEI. Similar results were reported in 2002, in a study of 98 patients (mean nodule volume 35.3 ml), with a shrinkage of >50% in 88% of individuals at the 9-year follow-up. The only prospective, randomized, double-blind study compared two groups of patients with cystic nodules who were treated with either ethanol or saline. The nodules were cured (i.e. residual cyst volumes ≤1 ml) in 27 of 33 PEI-treated patients, versus 16 of 33 saline-treated patients (P = 0.006).
In our opinion, PEI should be proposed as first-line therapy only for symptomatic, recurrent cystic nodules. For other types of nodules, PEI should be considered only when both surgery and RAI have been refused or are contraindicated.
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