Toxic goiter

Hyperthyroidism (thyrotoxicosis), defined as excessive thyroid activity, causes a state of thyroid hormone excess (thyrotoxicosis) characterized by an increased metabolic rate, increase in body temperature, sweating, tachycardia, tremor, nervousness, increased appetite and loss of weight. Common causes of hyperthyroidism are toxic multinodular goiter, toxic adenoma or diffuse toxic goitre ( Graves disease). Antithyroid diugs (methimazol, carbimazole, propylthiouracil) block thyroid hormone production and are hence suitable for the treatment of hyperthyroidism. 

III.b.1.6. Radioactive iodine. Radioactive iodine (Iodine-131) is a radioactive isotope of iodine, usually taken in an oral solution formulation as sodium 1. Given orally as sodium I, radioactive iodine is rapidly absorbed, concentrated and stored in the thyroid follicles. The therapeutic effect depends on beta-ray emission and destruction of thyroid parenchyma manifests some weeks after treatment. It is relatively safe, cheap, painless and avoids side effects associated with surgery. It is widely regarded as the treatment of choice in adults with toxic multinodular goiter, toxic nodule and people who relapse after a course of antithyroid medication. 

TOXIC UNINODULAR GOITER TOXIC MULTINODULAR GOITER... 

Toxic Uninodular Goiter Toxic Multinodular Goiter... 

Siegel RD, Lee SL. Toxic nodular goiter. Toxic adenoma and toxic multinodular goiter. Endocrinol Metab CUn North Am 1998 27 151-168. 

Method Toxic adenoma goiter Toxic diffuse goiter Thyroiditis Graves disease... 

Functionally, the state may be compensated up to a certain degree of iodine deficiency and for a considerable period of time, described in clinical terms as euthyroid diffuse or nodular goiter. Functional failure follows only in the presence of severe iodine deficiency, and hypothyroidism may then develop. Much more frequently and somewhat paradoxically, hyperthyroidism ensues after many years of iodine depletion. Rarely, hyperthyroidism may be found in cases of diffuse goiter, which are then termed as diffuse thyroid autonomy. Fiowever, hyperthyroidism frequendy occurs in conjunction with uninodular (toxic adenoma) and multinodular goiters (toxic multinodular goiter). 

Graves disease Hot nodule and toxic multinodular goiter Etiology ... 

Fuhrer D, Krohn K, Paschke R (2005) Toxic Adenoma and toxic Multinodular Goiter. In Braverman, LE Utiger (Hrsg.) RD (eds) Lippincott Williams Wilkins, ISBN 0-7817-5047-4, The Thyroid, 508-518... 

The common causes of thyrotoxicosis are shown in Table 41-6.29,30 Thyrotoxicosis can be related to the presence or absence of excess hormone production (hyperthyroidism). Graves disease is the most common cause of hyperthyroidism. Thyrotoxicosis in the elderly is more likely due to toxic thyroid nodules or multinodular goiter than to Graves disease. Excessive intake of thyroid hormone may be due to overtreatment with prescribed therapy. Surreptitious use of thyroid hormones also may occur, especially in health professionals or as a self-remedy for obesity. Thyroid hormones can be obtained easily without a prescription from health food stores or Internet sources. 

Primary hyperthyroidism Graves disease Toxic multinodular goiter... 

RAI is the agent of choice for Graves disease, toxic autonomous nodules, and toxic multinodular goiters. Pregnancy is an absolute contraindication to the use of RAI. 

Toxic Multinodal Goiter and Activating TSHR Mutations... 

Gabriel, E. M., Bergert, E. R., Grant, C. S., van Heerden, J. A., Thompson, G. B., and Morris, J. C. (1999) GermUne polymorphism of codon 727 of human thyroid-stimulating hormone receptor is associated with toxic multinodular goiter. J. Clin. Endocrinol. Metab. 84, 3328-3335. 

Tonacchera, M., Agretti, P., Chiovato, L., et al. (2000) Activating thyrotropin receptor mutations are present in nonadenomatous hyperfunctioning nodules of toxic or autonomous multinodular goiter. J. Clin. Endocrinol. Metab. 85, 2270-2274. 

It is nsed for hyperthyroid forms of endemic and sporadic goiters, diffnse, toxic goiters, and other illnesses accompanied by thyrotoxicity. Synonyms of this drug are ditirin, iodoglobin, and others. 

Surgery is usually a near-total thyroidectomy, with main indications being suspected coexistent thyroid carcinoma, solitary toxic nodule, large goiter, failed medical treatment, patient preference and occasionally in pregnancy if adverse effects from antithyroid dmgs occur. 

The manifestations of hyperthyroidism depend on the severity of the disease, the age of the patient, the presence or absence of extrathyroidal manifestations, and the specific disorder producing the thyrotoxicosis. Of the various types of hyperthyroidism, only two are common Graves disease and toxic multinodular goiter. Less common causes include toxic adenoma and postpartum thyroiditis, among others. 

In older patients toxic multinodular goiter typically presents as longstanding asymptomatic multinodular goiters. Functional autonomy of the nodules develops over time by an unknown mechanism and causes the disease to move from the nontoxic to the toxic phase. The onset of hyperthyroidism is gradual, and the symptoms are usually milder than those of Graves disease. 

Thyrotoxic crisis, thyroid storm, or accelerated hyperthyroidism is an extreme accentuation of thyrotoxicosis. Although uncommon, this serious complication of hyperthyroidism usually occurs in association with Grave s disease and occasionally with toxic multinodular goiter. 

Freitas JE. Therapeutic options in the management of toxic and nontoxic nodular goiter. Semin Nucl Med 2000 30(2) 88-97. 

The most common form of hyperthyroidism is Graves disease, or diffuse toxic goiter. The presenting signs and symptoms of Graves disease are set forth in Table 38-4. 

Beebe RT, Propp S, McClintock JC, Versaci A. Fatal agranulocytosis during treatment of toxic goiter with propylthiouracil. Ann Intern Med 1951 34(4) 1035-40. 

A number of observers in Europe and on this continent have drawn attention to the harmful effects that may result under some circumstances from the use of iodine. They have found that when it is employed for the prevention of goiter without due medicinal supervision, used in quack medicines or taken as iodized salt in irregular amounts for a long period, serious toxic symptoms may be provoked. 

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