In a multi-institute collaborative study, we assessed the potential clinical utility of thyroid hormone suppression therapy on benign multinodular thyroid disease. The study was performed using our previously developed method of quantitative research synthesis. This approach involved systematic review of the literature for relevant clinical studies and expert opinions, meta-analysis of selected interventional studies, surveys of NIH endocrinology practitioners for therapeutic decisions in hypothetic patients with benign multinodular thyroid disease, practice validation in NIH patients treated with levothyroxine suppression for benign multinodular thyroid disease, and application of Hill?s criteria to assess causality between thyroid suppression therapy and regression of benign nodules. Similar to our earlier observation for the effect of thyroid suppression therapy on benign solitary thyroid nodules, we found that a subset of patients with benign multinodular thyroid disease responded to this medical therapy with clinically significant reduction in nodule size. Consequently, an initial trial of this therapy is warranted in patients with benign multinodular thyroid disease in the absence of contraindication(s) to levothyroxine administration. In another study, we evaluated a case in which increased doses of levothyroxine replacement therapy were required to achieve euthyroid status in a patient with nephrotic syndrome. The clinical picture thus mimicked an """"""""inappropriate"""""""" thyroid-stimulating hormone (TSH) secretion syndrome.We analyzed the effect of various blood collection tubes on the measurements of free thyroxine (FT4), free iodothyronine (FT3), and TSH (thyroid-stimulating hormone or thyrotropin) with different nonisotopic methods. We observed clinically significant effects only with one type of collection tube on some assays. Nevertheless, the findings indicate that routine evaluation of these tubes is warranted before their use for thyroid function testing.
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