***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Patients with solitary thyroid nodules that are benign on aspiration biopsy are often treated nonsurgically . To find out if thyroxine therapy is effective , 74 patients were r and omized to receive levothyroxine treatment or nothing . There were 8 males and 66 females . Their mean age was 39 years . The mean nodule size was 3.6 cm and the mean nodule duration was 11 months . All patients had normal serum thyroxine and thyroid stimulating hormone ( TSH ) levels , and positive thyrotropin releasing hormone ( TRH ) tests . The dose of thyroxine was adjusted until the TRH test was negative . Patients were followed at 6-month intervals in the first 2 years and yearly thereafter , with measurement of the nodule diameter . The mean follow-up period was 1.5 years . In the 37 patients receiving thyroxine therapy , 8 had disappearance of nodules , 6 had greater than 50 % reduction in nodule size . In 19 , the nodules were unchanged and in 4 , the nodules were enlarged . In the 37 patients receiving no drug , 8 had disappearance of nodules , 5 had greater than a 50 % reduction in nodule size , 17 had nodules unchanged , and 7 had enlarged nodules ( p > 0.9 ) . The mean reduction in nodule diameter at various follow-up periods was greater in the thyroxine group , but the difference did not reach statistical significance . Carcinoma was found in 1 patient in each group and both of them experienced nodule enlargement . We conclude that an adequate suppressive dose of levothyroxine does not alter the natural course of benign solitary thyroid nodules . An enlargement of the nodule or a change in its consistency should be further investigated to exclude malignancy . RésuméLes patients présentant un nodule thyroïdien solitaire bénin à la biopsie par aiguille ne sont souvent pas traités chirurgicalement . Pour évaluer 1'efficacité de la thyroxine dans ces cas , 74 patients ont été r and omisés , recevant de la lévothyroxine ou rien . Il y avait 8 hommes et 66 femmes ; 1'âge moyen était de 39 ans . La taille moyenne du nodule était de 3.6 cm , et 1'évolution moyenne était de 11 mois . Tous les patients avaient un taux sérique de thyroxine et de TSH normal ; le test de la TRH était normal . La thyroxine a été dosée jusqu'à obtenir une réponse négative à la TRH . Les patients étaient suivis à intervalles de 6 mois pendant 2 ans puis une fois par an . Le diamètre du nodule etait mesuré à chaque examen . Le suivi moyen était de 1.5 ans . Pour 37 patients qui recevaient de la thyroxine , le nodule a disparu chez 8 et s'est réduit de plus de 50 % chez 6 . Le nodule était inchangé chez 19 et a continué d'évoluer chez 4 . Parmi les 37 patients n'ayant pas reçu de thyroxine , le nodule a disparu chez 8 , s'est réduit en taille de plus de 50 % chez 5 , est resté inchangé chez 17 et a augmenté de volume chez 7 ( p > 0.9 ) . La réduction moyenne du diamètre du nodule était supérieure chez les patients dans le groupe thyroxine mais cette différence n'était pas statistiquement significative . Dans chaque groupe , il y avait un cancer , et dans les deux cas , le nodule avait grossi . Nous concluons que la lévothyroxine aux doses suppressives ne modifie pas 1'évolution des nodules solitaires de la thyroïde . Une augmentation du volume ou une modification dans sa consistance dem and e des examens complémentaires pour exclure une évolution maligne . ResumenLos pacientes con nódulos tiroideos solitarios que demuestran ser benignos en la biopsia por aspiración frecuentemente reciben tratamiento no operatorio . Con el objeto de determinar si el tratamiento con tiroxina es efectivo , se estudiaron 74 pacientes mediante aleatorización : un grupo recibió levotiroxina y el otro ninguna terapia endocrina . El grupo tuvo 8 hombres y 66 mujeres ; la edad promedio fue 39 años . El tamaño promedio de los nódulos fue 3.6 cm y el promedio de evolución del nódulo fue 11 meses . La totalidad de los pacientes exhibió niveles séricos de tiroxina y de TSH normales , y pruebas normales de TRH . La dosis de tiroxina fue ajustada hasta que la prueba de TRH result ó negativa . Los pacientes fueron seguidos a intervalos de 6 meses en el curso de los primeros 2 años , y anualmente de ahí en adelante , registr and o en cada visita el diámetro del nódulo . El promedio del seguimiento fue 1.5 años . En el grupo de 37 pacientes tratados con tiroxina  , 8 exhibieron desaparición de los nódulos y 6 reducción de más del 50 % en el tamaño del nódulo ; en 19 los nódulos no demostraron cambio y en 4 aumentaron de tamaño . En los 37 pacientes que no recibieron terapia , 8 demostraron desaparición del nódulo y 5 reduccción de más del 50 % en su tamaño ; en 17 el nódulo no modificó el tamaño y en 7 el nódulo se agr and ó ( p > 0.9 ) . La reducción promedio en el diámetro del nódulo observada en los diferentes períodos de seguimiento fue mayor en el grupo tratado con tiroxina , pero la diferencia no alcanzó significancia estadística . Se halló carcinoma en un paciente en cada grupo , y ambos mostraron crecimiento del nódulo . Hemos concluído que una dosis supresiva de levotiroxina no altera la evolución natural de los nódulos tiroideos benignos . El crecimiento del nódulo o un cambio en su consistencia debe ser investigado para excluir posible malignidad High-frequency ultrasound examination of the thyroid was performed in 253 subjects ( 130 women and 123 men ; age range , 19 - 50 years ) that were r and omly selected from the population in an area of Finl and where goiter is not endemic .  Thyroid echo abnormalities were detected in 69 subjects ( 27.3 % ) . Prevalence of abnormalities increased with age , and women showed more lesions than did men in each of the 3 decades . The abnormality was solitary in 39 subjects ( 57 % ) , multiple in 15 ( 22 % ) , and diffuse in 15 ( 22 % ) . Of the 68 individual nodules , 48 ( 70 % ) were smaller than 1 cm in diameter . Anechoic rounded nodules 1 - 5 mm in diameter were found in 28 subjects . Fine-needle aspiration biopsy  was performed in 30 subjects . Cytologic examination revealed no unequivocal malignancies . In eight subjects ( 3.2 % ) with a diffuse echo abnormality , cytologic evaluation indicated lymphocytic thyroiditis . It is concluded that the prevalence of small thyroid echo abnormalities in a r and omly selected adult population is rather high , a fact that supports use of a conservative approach to these types of findings Abstract Objective . Many patients with nonerosive reflux disease ( NERD ) have insufficient relief on proton pump inhibitors ( PPIs ) . Some patients have a hypersensitive esophagus and may respond to transient receptor potential vanilloid 1 ( TRPV1 ) antagonists . Aim . To investigate the effect of the TRPV1 antagonist AZD1386 on experimental esophageal pain in NERD patients . Material and methods . Enrolled patients had NERD and a partial PPI response ( moderate-to-severe heartburn or regurgitation ≥3 days/week before enrolment despite ≥6 weeks ' PPI therapy ) . Fourteen patients ( 21–69 years , 9 women ) were block-r and omized into this placebo-controlled , double-blinded , crossover study examining efficacy of a single dose ( 95 mg ) of AZD1386 . On treatment days , each participant 's esophagus was stimulated with heat , distension , and electrical current at teaching hospitals in Denmark and Sweden . Heat and pressure pain served as somatic control stimuli . Per protocol results were analyzed . Results . Of 14 r and omized patients , 12 were treated with AZD1386 . In the esophagus AZD1386 did not significantly change the moderate pain threshold for heat [ –3 % , 95 % confidence interval ( CI ) , –22;20 % ] , distension ( –11 % , 95 % CI , –28;10 % ) , or electrical current ( 6 % , 95 % CI , –10;25 % ) . Mean cutaneous heat tolerance increased by 4.9 ° C ( 95 % CI , 3.7;6.2 ° C ) . AZD1386  increased the maximum body temperature by a mean of 0.59 ° C ( 95 % CI , 0.40–0.79 ° C ) , normalizing within 4 h. Conclusions . AZD1386 had no analgesic effect on experimental esophageal pain in patients with NERD and a partial PPI response , whereas it increased cutaneous heat tolerance . TRPV1 does not play a major role in heat- , mechanically and electrically evoked esophageal pain in these patients . Clinical Trials.gov identifier : D9127C00002 OBJECTIVE To study the efficacy of levothyroxine suppressive therapy in the management of  benign thyroid nodules .  METHODS We performed a double-blind clinical trial comparing levothyroxine treatment ( 1.5 to 2.0 mg/kg of body weight daily ) ( N = 32 ) with placebo  ( N = 30 ) for a 1-year period in patients with a benign , cold thyroid nodule confirmed by biopsy and 99mTc-pertechnetate scanning , who were r and omly assigned to the treatment or control group .  High-resolution sonography was used to measure the size of the nodules before and after the treatment . Suppression of thyrotropin was evaluated by the administration of thyrotropin-releasing hormone to 10 patients r and omly in each group . RESULTS The mean volume of the thyroid nodules decreased significantly after 6 months in both the levothyroxine group ( from 12.8 + /- 11.9 mL to 9.4 + /- 9.8 mL ; P = 0.003 ) and the placebo group ( from 13.2 + /- 10.2 mL to 11.5 + /- 8.0 mL ; P = 0.003 ) . After 12 months , however , the volume of the nodules had increased . Thus , no significant decrease was found in the mean nodule volume in either study group at 1 year in comparison with the mean volume at baseline ( final mean volume : 12.4 + /- 16.7 mL in the levothyroxine group and 11.7 + /- 13.6 mL in the placebo group ) . CONCLUSION Suppressive therapy with levothyroxine for a period of 12 months proved to be ineffective in significantly reducing the size of the thyroid nodules in our patients despite effective suppression of the thyrotropin level OBJECTIVE We examined the effects of l‐thyroxine therapy versus placebo over a 12‐month period on volume of solitary thyroid nodules PURPOSE To prospect ively evaluate the efficacy of additional radiofrequency ( RF ) ablation by comparing the results of one and two sessions . MATERIAL S AND METHODS All patients gave written informed consent to participate in this institutional review board-approved prospect i ve study . From September 2007 to February 2008 , 30 patients with benign predominantly solid thyroid nodules causing pressure symptoms and /or cosmetic problems were r and omly assigned to undergo single-session ( group 1 , n = 15 ) or two-session ( group 2 , n = 15 ) RF ablation . RF ablation was performed by using an 18-gauge internally cooled electrode with ultrasonographic guidance . Nodule volume and cosmetic and symptom scores were evaluated before ablation and at 1 , 3 , and 6 months after initial ablation , and quantitative comparisons of these were performed by using the Mann-Whitney and Wilcoxon signed rank tests ; the Spearman rank test was used for correlation between nodule volume reduction and applied energy . RESULTS At 6-month follow-up , there was significant nodule volume reduction , from 13.3 mL ± 12.9 ( st and ard deviation ) to 3.8 mL ± 4.4 in group 1 ( P = .001 ) , and from 13.0 mL ± 6.8 to 3.0 mL ± 2.2 in group 2 ( P = .001 ) . Each group showed significant improvement in cosmetic ( P < .0001 ) and symptom ( P = .001 ) scores . However , there was no significant difference in volume reduction , cosmetic score , and symptom score between two groups ( P = .078 , P > .99 , and P = .259 , respectively ) . In group 1 , three of four patients who had a pretreatment nodule volume larger than 20 mL underwent additional RF ablation because of unresolved clinical problems after the first session . 
    Output:
    
Pressure symptoms or cosmetic complaints were not investigated in LT4 studies .
Nodule volume reductions were achieved by PEI , LP and RF , and to a lesser extent , by LT4 .
However , the clinical relevance of this outcome measure is doubtful .
PEI , LP and RF led to improvements in pressure symptoms and cosmetic complaints .
Adverse events such as light-to-moderate periprocedural pain were seen after PEI , LP and RF .