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Endocrine Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Goitrogens in diet (e.g. excess dietary iodine related to eating seaweed, cassava root) may contribute to multinodular goitre development. Individual nodules may become autonomous, with clinical hyperthyroidism. Toxic adenoma refers to an autonomous hyperfunctioning thyroid nodule with raised fT4/fT3 and suppressed TSH. The appearance of a multinodular goitre is shown in Figure 12.32.
Benign Thyroid Disease
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Treatment strategies for thyrotoxicosis are categorised into medical, nuclear medicine, and surgical approaches. Medical management entails antithyroid drugs ± beta blockers. Thionamines are prescribed in a ‘block and replace’ or titration regimen. The most common side-effect is pruritic rash. The most serious side-effects are agranulocytosis and liver failure. Lugol's iodine solution is variably used as a second-line control in the work-up for surgery. Radioiodine is safe and effective and is considered first-line treatment in the elderly and those with cardiac dysfunction who may not tolerate physiological stress of surgery. Surgery is the preferred option in toxic multinodular goitre, in those with compressive symptoms, and in Graves’ disease associated with eye disease.
Endocrine Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
What are the causes of a multinodular goitre?Most MNGs are due to enlargement of a simple goitre, which develops due to TSH stimulation secondary to low levels of thyroid hormones. Iodine deficiency causes an endemic simple goitre, which appears in childhood and evolves into a colloid goitre at a later stage.The increased demand for thyroid hormone in pregnancy and puberty causes enlargement of a goitre.Dietary goitrous agents in brassica vegetables, lithium and carbimazole also induce goitres.Rare hereditary congenital defects in thyroid metabolism also cause goitres.Sporadic MNG can occur, commonly affecting middle-aged women.Previous radiotherapy to the neck (e.g. lymphoma) can also cause goitres.
Papillary thyroid carcinoma with hobnail features showing rapid progression and therapy resistance
Published in Acta Chirurgica Belgica, 2021
Anton De Graef, Klaas Van Den Heede, Vanessa Meert, Sam Van Slycke
A 38-year-old woman was referred to our department for evaluation of a fast-growing and very voluminous multinodular goitre with bilateral lateral neck adenopathy. The patient had noted an enlarged thyroid gland, clinically visible for 2 months. She expressed substantial and progressively increasing neck discomfort with stridor, the sensation of suffocation, hoarse voice, systemic malaise with nausea, and a significant weight loss over the last 3 months (12 kg). For 4 months she noted discrete dyspnoea and insomnia with coughing episodes. She was a smoker (15–20 cigarettes/day) without any relevant medical history. She denied any chills, fever or any other clinical signs of infection. Her familial history was positive for thyroid disease.
Relationship between metabolic syndrome and nodular thyroid diseases
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2018
Seher Kir, Yusuf Aydin, Hulya Coskun
A ‘goitre’ refers to any type of enlargement of the thyroid gland. The enlargement can be diffuse, nodular (one solid nodule) or multinodular (more than one nodule), and it may be present in those with hypothyroidism, hyperthyroidism or normal thyroid functions [1]. A nodular goitre (NG) is a clinically recognizable enlargement of the thyroid gland that is characterized by excessive growth and structural or functional transformation of one or several areas within normal thyroid tissue [2]. In our study, a solitary thyroid nodule is referred to as a NG, and more than one thyroid nodule is referred to as a multinodular goitre (MNG).
Nodule size as predictive factor of efficacy of radiofrequency ablation in treating autonomously functioning thyroid nodules
Published in International Journal of Hyperthermia, 2018
R. Cesareo, A. M. Naciu, M. Iozzino, V. Pasqualini, C. Simeoni, A. Casini, G. Campagna, S. Manfrini, G. Tabacco, A. Palermo
With regard to laser technology, taking into account differences related to different energy, we noticed the same variability of outcomes we observe with RFA. In detail, the rate of normalisation of TSH in patients with multinodular goitre treated with LA were between 47–87% within 6–12 months. The energy was delivered in multiple sessions (1–9) [31–33] or with multiple cycles of treatment [34]. The rate of patients with euthyroidism ranged from 50 to 88% [33,34]. All these studies have been conducted predominantly on a small series of cases.