Toxic Adenoma natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
If left untreated, some of the patients with toxic adenoma may progress to develop [[thyrotoxicosis]] which increases the risks of [[atrial fibrillation]], [[heart failure]], and decreased [[bone mineral density]] in [[postmenopausal]] women ([[osteoporosis]]). Common complications of toxic adenoma include [[atrial fibrillation]], neck compression, bone mineral loss, [[thyroid storm]], I-131-related [[hypothyroidism]]. [[Prognosis]] of toxic adenoma is generally good with treatment. About 45% to 75% of patients stay [[euthyroid]] following [[Iodine-131|I-131 therapy]]. | |||
==Natural History== | ==Natural History== | ||
*If left untreated, | *If left untreated, some of the patients with toxic adenoma may progress to develop [[thyrotoxicosis]].<ref name="pmid11567699">{{cite journal |vauthors=Parle JV, Maisonneuve P, Sheppard MC, Boyle P, Franklyn JA |title=Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year cohort study |journal=Lancet |volume=358 |issue=9285 |pages=861–5 |year=2001 |pmid=11567699 |doi=10.1016/S0140-6736(01)06067-6 |url=}}</ref><ref name="pmid15145238">{{cite journal |vauthors=Pearce EN, Braverman LE |title=Hyperthyroidism: advantages and disadvantages of medical therapy |journal=Surg. Clin. North Am. |volume=84 |issue=3 |pages=833–47 |year=2004 |pmid=15145238 |doi=10.1016/j.suc.2004.01.007 |url=}}</ref> | ||
*Nodule size is a strong predictor of whether thyrotoxicosis will develop in solitary adenomas. | *[[Nodule]] size is a strong predictor of whether [[thyrotoxicosis]] will develop in solitary adenomas. | ||
*Most autonomously functioning thyroid nodules that become thyrotoxic are larger than 2.5 to 3 cm in diameter. | *Most autonomously functioning [[Thyroid nodule|thyroid nodules]] that become thyrotoxic are larger than 2.5 to 3 cm in diameter. | ||
*Consequences of untreated toxic multinodular goiter are due to | *Consequences of untreated toxic multinodular goiter are due to [[hyperthyroidism]] or [[thyrotoxicosis]] which includes increased risks of [[atrial fibrillation]], [[heart failure]], and decreased [[bone mineral density]] in [[postmenopausal]] women. | ||
*Spontaneous resolution of a toxic adenoma can occur very rarely because of hemorrhage, cystic degeneration, and loss of autonomous function. | *Spontaneous resolution of a toxic adenoma can occur very rarely because of [[hemorrhage]], cystic degeneration, and loss of autonomous function. | ||
==Complications== | ==Complications== | ||
Complications of toxic adenoma are mainly due thyrotoxicosis which includes constellation of symptoms and signs caused by excess circulating and tissue free triiodothyronine ( | Complications of toxic adenoma are mainly due [[thyrotoxicosis]] which includes a constellation of symptoms and signs caused by excess circulating and tissue free [[triiodothyronine]] (T3 ), [[Thyroxine|free thyroxine]] (T4 ), or both. These result in [[hypermetabolism]] and other excessive tissue-specific [[Thyroid hormones|thyroid hormone]] effects. Common complications of toxic adenoma include:<ref name="pmid24273583">{{cite journal |vauthors=Ertek S, Cicero AF |title=Hyperthyroidism and cardiovascular complications: a narrative review on the basis of pathophysiology |journal=Arch Med Sci |volume=9 |issue=5 |pages=944–52 |year=2013 |pmid=24273583 |pmc=3832836 |doi=10.5114/aoms.2013.38685 |url=}}</ref> | ||
*[[Atrial fibrillation]] | *[[Atrial fibrillation]] | ||
* | *[[Heart failure]] | ||
*Bone mineral loss | *Facial [[plethora]] | ||
*Thyroid storm | *Inspiratory [[stridor]] | ||
*I-131-related hypothyroidism | *[[Hoarseness]] | ||
*Surgery-related | *[[Dysphagia]] | ||
**Hypothyroidism | *[[Osteoporosis|Bone mineral loss]] | ||
**Recurrent laryngeal nerve damage | *[[Thyroid storm]] | ||
**Hypoparathyroidism | *[[Iodine-131|I-131]]-related [[hypothyroidism]] | ||
*Antithyroid drug-related agranulocytosis | *[[Surgery]]-related | ||
**[[Hypothyroidism]] | |||
**[[Laryngeal nerve palsy|Recurrent laryngeal nerve damage]] | |||
**[[Hypoparathyroidism]] | |||
*[[Antithyroid]] drug-related [[agranulocytosis]] | |||
==Prognosis== | ==Prognosis== | ||
*Prognosis of toxic adenoma is generally good with treatment. | *Prognosis of [[toxic adenoma]] is generally good with treatment. | ||
*About 45% to 75% of patients stay euthyroid following I-131 therapy. | *About 45% to 75% of patients stay [[euthyroid]] following I-131 [[therapy]]. | ||
*Both surgery and radioactive iodine therapy can confer a moderate long-term risk of hypothyroidism.<ref name="pmid15577585">{{cite journal |vauthors=Erdoğan MF, Küçük NO, Anil C, Aras S, Ozer D, Aras G, Kamel N |title=Effect of radioiodine therapy on thyroid nodule size and function in patients with toxic adenomas |journal=Nucl Med Commun |volume=25 |issue=11 |pages=1083–7 |year=2004 |pmid=15577585 |doi= |url=}}</ref><ref name="pmid15496625">{{cite journal |vauthors=Hegedüs L |title=Clinical practice. The thyroid nodule |journal=N. Engl. J. Med. |volume=351 |issue=17 |pages=1764–71 |year=2004 |pmid=15496625 |doi=10.1056/NEJMcp031436 |url=}}</ref> | *Both [[surgery]] and [[radioactive iodine]] therapy can confer a moderate long-term risk of [[hypothyroidism]].<ref name="pmid15577585">{{cite journal |vauthors=Erdoğan MF, Küçük NO, Anil C, Aras S, Ozer D, Aras G, Kamel N |title=Effect of radioiodine therapy on thyroid nodule size and function in patients with toxic adenomas |journal=Nucl Med Commun |volume=25 |issue=11 |pages=1083–7 |year=2004 |pmid=15577585 |doi= |url=}}</ref><ref name="pmid15496625">{{cite journal |vauthors=Hegedüs L |title=Clinical practice. The thyroid nodule |journal=N. Engl. J. Med. |volume=351 |issue=17 |pages=1764–71 |year=2004 |pmid=15496625 |doi=10.1056/NEJMcp031436 |url=}}</ref> | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Medicine]] | |||
[[Category:Endocrinology]] | |||
[[Category:Up-To-Date]] | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
If left untreated, some of the patients with toxic adenoma may progress to develop thyrotoxicosis which increases the risks of atrial fibrillation, heart failure, and decreased bone mineral density in postmenopausal women (osteoporosis). Common complications of toxic adenoma include atrial fibrillation, neck compression, bone mineral loss, thyroid storm, I-131-related hypothyroidism. Prognosis of toxic adenoma is generally good with treatment. About 45% to 75% of patients stay euthyroid following I-131 therapy.
Natural History
- If left untreated, some of the patients with toxic adenoma may progress to develop thyrotoxicosis.[1][2]
- Nodule size is a strong predictor of whether thyrotoxicosis will develop in solitary adenomas.
- Most autonomously functioning thyroid nodules that become thyrotoxic are larger than 2.5 to 3 cm in diameter.
- Consequences of untreated toxic multinodular goiter are due to hyperthyroidism or thyrotoxicosis which includes increased risks of atrial fibrillation, heart failure, and decreased bone mineral density in postmenopausal women.
- Spontaneous resolution of a toxic adenoma can occur very rarely because of hemorrhage, cystic degeneration, and loss of autonomous function.
Complications
Complications of toxic adenoma are mainly due thyrotoxicosis which includes a constellation of symptoms and signs caused by excess circulating and tissue free triiodothyronine (T3 ), free thyroxine (T4 ), or both. These result in hypermetabolism and other excessive tissue-specific thyroid hormone effects. Common complications of toxic adenoma include:[3]
- Atrial fibrillation
- Heart failure
- Facial plethora
- Inspiratory stridor
- Hoarseness
- Dysphagia
- Bone mineral loss
- Thyroid storm
- I-131-related hypothyroidism
- Surgery-related
- Antithyroid drug-related agranulocytosis
Prognosis
- Prognosis of toxic adenoma is generally good with treatment.
- About 45% to 75% of patients stay euthyroid following I-131 therapy.
- Both surgery and radioactive iodine therapy can confer a moderate long-term risk of hypothyroidism.[4][5]
References
- ↑ Parle JV, Maisonneuve P, Sheppard MC, Boyle P, Franklyn JA (2001). "Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year cohort study". Lancet. 358 (9285): 861–5. doi:10.1016/S0140-6736(01)06067-6. PMID 11567699.
- ↑ Pearce EN, Braverman LE (2004). "Hyperthyroidism: advantages and disadvantages of medical therapy". Surg. Clin. North Am. 84 (3): 833–47. doi:10.1016/j.suc.2004.01.007. PMID 15145238.
- ↑ Ertek S, Cicero AF (2013). "Hyperthyroidism and cardiovascular complications: a narrative review on the basis of pathophysiology". Arch Med Sci. 9 (5): 944–52. doi:10.5114/aoms.2013.38685. PMC 3832836. PMID 24273583.
- ↑ Erdoğan MF, Küçük NO, Anil C, Aras S, Ozer D, Aras G, Kamel N (2004). "Effect of radioiodine therapy on thyroid nodule size and function in patients with toxic adenomas". Nucl Med Commun. 25 (11): 1083–7. PMID 15577585.
- ↑ Hegedüs L (2004). "Clinical practice. The thyroid nodule". N. Engl. J. Med. 351 (17): 1764–71. doi:10.1056/NEJMcp031436. PMID 15496625.