Goiter nodular

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

Extensive iodine absorption from povidone-iodine can cause transient hypothyroidism or in patients with latent hypothyroidism the risk of destabilization and thyrotoxic crisis (SEDA-20, 226 SEDA-22, 263). Especially at risk are patients with an autonomous adenoma, localized diffuse autonomy of the thyroid gland, nodular goiter, latent hyperthyroidism of autoimmune origin, or endemic iodine deficiency (51). 

Appetecchia M. Effects on bone mineral density by treatment of benign nodular goiter with mildly suppressive doses of L-thyroxine in a cohort women study. Horm Res 2005 64(6) 293-8. 

Distribution of I131 and I127 in sera of patients with nontoxic nodular goiter. In Advance in Thyroid Research Trans, of the 4th Internat. Conf. on Goiter, London, 1960, R. Pitt-Rivers, ed., 2 vols. Pergamon Press, London, 1961. With S. C. Werner, I. Radichevich, V. V. Row, and R. H. Mandl. 

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). 

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

Iodine Hypothyroid goiter, neuromuscular impairment, deaf-mutism, increased embryonic and postnatal mortality, cognitive impairment, impaired fertility, cretinism (severe cases) Thyrotoxicosis nodular goiter, weight loss, tachycardia, muscle weakness, warm skin Decreased long-term inadequate intake... 

Numerous other proteins have been explored as potential markers for different types of thyroid malignancies (Table 10.3). Cbp/p300-interacting transactivator 1 (CITEDl) is a nuclear protein that is involved in the coregulation of transcription factors. This protein is present in a variety of different cell types and is overexpressed in papillary thyroid carcinomas (87% to 93%). However, CITEDl immunoreactivity is also expressed in up to 50% of follicular carcinomas, 16% of follicular adenomas, and 24% of nodular goiters. 

Nodular goiters are more common in the elderly and can be associated with euthyroid or hyperthyroid state,... 

Treatment of goiter is dependent on the type of goiter, i.e., diffuse vs. nodular goiter. 

When iodine requirements are not met, TH synthesis is reduced, resulting in enlargement of the thyroid gland to compensate for this reduction. In adults, mild iodine deficiency (ID) is associated with nontoxic nodular goiter and, less often, with toxic nodular goiter, due to increases in the constitutive (thyrotropin-independent) growth and functional potential of some clones of thyroid cells. In pregnancy, this can result in fetal neurodevelopmental deficits and mental retardation. 

The most serious and common complication of salt iodization is the development of iodine-induced hyperthyroidism (IIH), which affects mainly older people with nodular goiter another possibifity is the aggravation or even the induction of autoimmune thyroiditis. IIH has been reported in almost all iodine supplementation programs in countries with history of severe ID (Stanbury et ai, 1998). However, IIH can occur following iodine supplementation in areas with previous sufficient iodine intake Galofre et al. (1994) the authors have reported increased incidence of both nodular and Graves hyperthyroidism. Also, increased iodine intake is associated with increased incidence of thyroid autoimmune diseases (Papanastasiou et al, 2000 Zois etai, 2003) (Figure 73.4). 

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). 

While the efficacy of both levothyroxine and iodine in existing disease is limited, prevention of the occurrence or recurrence of diffuse or nodular goiter is readily achieved by small amounts of iodine correcting iodine deficiency. 

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