Treatment of toxic adenoma and toxic multinodular goiter
- Douglas S Ross, MD
Douglas S Ross, MD
- Section Editor — Thyroid Disease
- Professor of Medicine
- Harvard Medical School
Toxic adenoma and toxic multinodular goiter (MNG) are common causes of hyperthyroidism, second in prevalence only to Graves' disease. The prevalence of toxic nodular goiter increases with age and in the presence of iodine deficiency, and may therefore be more common than Graves’ disease in older populations in regions of iodine deficiency. Toxic adenoma and MNG are the result of focal and/or diffuse hyperplasia of thyroid follicular cells whose functional capacity is independent of regulation by thyroid-stimulating hormone (TSH). Twenty to 80 percent of toxic adenomas and some nodules of multinodular goiters have somatic mutations of the TSH receptor gene that confers autonomous hyperactivity [1,2].
The treatment of toxic adenoma and MNG will be presented here. The clinical presentation, evaluation, and diagnosis of hyperthyroidism and of goiter, as well as the treatment of other causes of hyperthyroidism, are reviewed separately.
●(See "Diagnosis of hyperthyroidism".)
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- CONFIRM THE ETIOLOGY OF HYPERTHYROIDISM
- INDICATIONS FOR TREATMENT
- THERAPEUTIC APPROACH
- Symptom control
- Decrease thyroid hormone synthesis
- - Choice of therapy
- - Indications
- - Extent of resection
- - Preoperative preparation
- - Complications
- Radioiodine therapy
- Thionamide administration
- - Pretreament before radioiodine or surgery
- - Long-term administration
- Other therapies
- Monitoring after therapy
- - Radioiodine
- - Surgery
- Persistent or recurrent disease
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS