Treatment of the autonomous thyroid nodule: a review
Abstract
Pathophysiological and clinical aspects of the autonomous thyroid nodule have been reviewed previously (1, 2). Interest in this disease has been renewed in recent years by exciting molecular studies showing that somatic mutations activating the TSH receptor are the main cause of autonomous adenoma (3–6). For the purposes of the present discussion on the treatment of this disease, it is sufficient to recall that it may present at one of three clinical stages (1, 2, 7–9): "compensated" nodule, i.e. a nodule that is hot or warm at scintigraphy performed with a radioisotope of iodine (to exclude the possibility of a nodule of the trapping-only type (10)) but that fails to inhibit completely or substantially the radionuclide uptake by the extranodular tissue; patients with compensated nodules have detectable and usually normal serum TSH, as well as normal free (F) thyroid hormone levels (FT3 and FT4); non-toxic or "pretoxic" nodule, i.e. a hot nodule without consistent extranodular uptake, with undetectable TSH, but FT3 and FT4 still within the normal range; toxic nodule, i.e. a nodule that inhibits TSH secretion and extranodular uptake and also secretes thyroid hormones in sufficient amounts to induce supranormal FT3 and/or FT4 serum levels.
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The prevalence of hypothyroidism following RAI therapy is increased by normalization or elevation of TSH at the time of treatment resulting from ATD pretreatment or use of rhTSH and by the presence of antithyroid antibodies.
“The prevalence of hypothyroidism following RAI therapy is increased by normalization or elevation of TSH at the time of treatment resulting from ATD pretreatment or use of rhTSH and by the presence of antithyroid antibodies (278).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [278]
Patients with positive antithyroid antibodies preoperatively have a higher risk of postoperative hypothyroidism.
“Patients with positive antithyroid antibodies preoperatively have a higher risk of postoperative hypothyroidism (256,278).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [278]
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“RAI administered to treat TA can be given either as a fixed activity of approximately 10–20 mCi (370–740 MBq) or an activity calculated on the basis of nodule size using 150– 200 lCi (5.5–7.4 MBq) RAI per gram corrected for 24-hour RAIU (278).”
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“The prevalence of hypothyroidism following 131I therapy is increased by normalization or elevation of TSH at the time of treatment resulting from ATD pretreatment and by the presence of antithyroid antibodies (166).”
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“The prevalence of hypothyroidism following (131)I therapy is increased by normalization or elevation of TSH at the time of treatment resulting from ATD pretreatment and by the presence of antithyroid antibodies (166).”
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BackgroundInfluentialRadiofrequency Ablation for an Autonomously Functioning Thyroid Nodule
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“Radioiodine and surgery are both effective in the treatment of pretoxic as well as toxic thyroid nodules (TTNs) [3].”
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“Therefore, wellknown non-operative treatments such as levothyroxine (5) and 131I therapy (6, 7) are being used more and more frequently and in addition new methods are being developed (8, 9).”
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“Several factors have been identified to explain this occurrence; in particular, partial iodine uptake suppression of the ENLobe, often due to pretreatment with antithyroid drugs, is regularly reported [16,23].”
Influential
- Authors
- Ferrari, C., Reschini, E., & Paracchi, A.
- Affiliations
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- ORCID
- Ferrari, Carlo
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 1996-10
- Volume
- 135
- Issue
- 4
- Pages
- 383-390
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W2007974905
- Cited by
- 85
- References
- 0
- Citations by year
- 2025: 1 · 2024: 3 · 2022: 2 · 2021: 1 · 2020: 2 · 2019: 1 · 2018: 3 · 2017: 3 · 2016: 3 · 2015: 2 · 2014: 3 · 2012: 3
- FWCI
- 2.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- autonomously functioning thyroid nodules, toxic multinodular goiter, autonomous thyroid adenoma, TSH receptor mutations, nodule classification, radioiodine therapy
- MeSH terms
- Ethanol, Humans, Injections, Iodine Radioisotopes, Thyroid Nodule
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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