Goitre nodular

Figure 9. Chromatograms of blank sample (a), standard mixture (b), sample of thyroid from the control group (c), and sample of thyroid of a patient with diagnosed nodular goitre (d) [22].

Radioactive iodine is indicated in hyperthyroidism due to Graves disease or toxic nodular goitre and also used as palliative therapy after thyroidectomy for papillary carcinoma of thyroid. 

Bliddal H, Hansen JM, Rogowski P, Johansen K, Friis T, Siersbaek-Nielsen K. 131I treatment of diffuse and nodular toxic goitre with or without antithyroid agents. Acta Endocrinol (Copenh) 1982 99(4) 517-21. 

Levothyroxine has been used in the treatment of nontoxic nodular goiter. In such patients it suppresses TSH secretion, and treatment is given on the assumption that nodular (like normal) thyroid tissue growth is dependent on TSH. The long-term value of levothyroxine in these patients remains unproven, and withdrawal of therapy leads to return of the goitre. Levothyroxine should not be used to treat obesity (see Obesity). 

This term is sometimes used of patients with normal serum T and T but xmdetectable TSH levels. Some of these patients progress to frank hyper-th)TOidism, with an increased risk of atrial fibrillation and osteoporosis in the elderly. This is most likely in patients with nodular goitres. In the remainder, treatment is unnecessary, but thyroid-function tests should be performed every six months. 

Acute thyrotoxicosis (TTX) developed several days following a coronary angioplasty procedure necessitating 260 ml of iodixanol (320 mg/ml iodine-containing contrast media) in a 72-year-old age male with cardiovascular disease and prior thyroid toxic nodular goitre. Euthyroid status was established with carbimazole treatment [19A]. 

Fig. 1. The percentage of toxic nodular goitre (TNG) in patients with thyrotoxicosis before and after the introduction of iodine prophylaxis which was intensified in the early 60 s. A decrease is seen at the end of the 60 s in the Helsinki material which comprises all thyrotoxic patients 7,20,21 and during the 70 s in patients treated with ra-dioiodine The Tampere material comprises patients operated for thyrotoxicosis .

During about 40 years of iodine prophylaxis the endemic goitre in Finland is disappearing. Endemic goitre occurs mainly in subjects over 40-45 years of age. Toxic nodular goitre has markedly decreased. The daily iodine intake has remained around 300 ug since the 70 s. By extrapolation it can be assumed that by the year 2025 the endemic goitre has totally disappeared. 

Treatment of toxic nodular and diffuse goitre with radioactive iodine, Acta Endocrinol. (Copenh)... 

It has long been assumed that in relatively iodine deficient areas, IHT occurred in nodular goitres as a consequence of an underlying thjnroid dysfunction. Our data suggest that there exists 2 types of toxic nodules one, relat to autoimmune phenomena, that has lost the capability to store iodine, the other, true autonomous , that has kept this capability. The latter type seems to be at the origin of IHT in iodine deficient areas. They also support the notion that iodide excess results in the preferential secretion of T4 and show unexpect y that an increased IU does not exclude the diagnosis of IHT. 

In the presence of thyroid disease, and in areas with endemic iodine deficiency, suddenly raising daily iodine intake may precipitate hyperthyroidism, and this has been the subject of some concern as salt iodization efforts proceed with fledgling quality assurance. This effect is felt to be related in part to autonomous nodules in the gland that synthesize and release excess thyroid hormone. The exact prevalence of iodine-induced hyperthyroidism in deficient areas is not clear. Many coim-tries initiating salt iodization programs have reported increases in the incidence of toxic nodular goitre and iodine-induced thyrotoxicosis, usually in older people. While this may be a significant clinical problem, the risk is estimated to be between 0.01 and 0.06% and must be... 

---