Autonomous Nodules Research Articles

The autonomous functioning thyroid nodule in the evolution of nodular goiter.

ABSTRACT Autoradiographic studies of the thyroids of 21 patients with a gross autonomous functioning nodule demonstrated similar small or micronodules in 76 %. They were also present in 4 glands in which a large cyst was the dominant nodule. In only 14 % of 29 patients with nonfunctioning macronodules were these tiny functioning nodules found. These data suggest that hot macronodules evolve with secretory activity from their origin, but they do not support the hypothesis of a common functional stage for all nodules. Transition from a functioning to a nonfunctioning nodule may occur through degenerative change or possibly by simple loss of functional capacity of the follicles. The appearance of the latter change in our series does not suggest that it can account for a large number of cold nodules. The histologic appearance of the smallest observed functioning nodules has been found to be that previously thought to be associated with the absorption of colloid from a large follicle and the ultimate partition...

Why Not Radioiodine Therapy for Toxic Nodular Goiter?

THE USE of radioiodine as the preferred therapy for toxic nodular goiter (TNG) is still controversial. Many investigators remain opposed to this approach. 1-16 Usually radioiodine is used only if the patient refuses surgery or if surgery is contraindicated. Only a few investigators favor radioiodine therapy for TNG. 17-21 Silver 21 is included among them but even in his extensive paper he dealt mostly with small goiters. The estimated average weight was 53 gm, and only 22 of 282 patients had goiters larger than 110 gm. Good results have been reported with the use of radioiodine therapy for TNG. Good results were obtained even by those who argue against its use, 4,6,7,10-16 and even with large multinodular goiters, including those with tracheal compression. 15,16,19 Solitary autonomous hyperfunctioning nodules are excluded from this study. Our approach to the diagnosis and management of this intriguing lesion has been published. 22,23 This paper offers experience with patients with large

The thyroid scintigram. II. The cold nodule.

The Thyroid scintigram has not been found decisive for the identification of malignancy in thyroid nodules (1–12). Correct delineation of its sphere of usefulness has been delayed by three factors. First, proper attention has not been given to technical aspects of the scanning procedure. Second, many physicians have failed to interpret the scintigram in the light of the total information available from the patient. Third, there has been infrequent correlation of scintigram patterns and autoradiographs of the related tissue. In a previous publication we discussed the scintigram diagnosis of the hot autonomous nodule and offered arguments for its probable benign nature (13). Others have stressed the high incidence of thyroid cancer in cold nodules (1, 3, 5, 6, 14), a statistic heavily weighted by selection. They have called attention to the inverse correlation of function, as judged from the scintigram, and the probability of thyroid cancer. Nodules with little or no autonomous function have been subdivided...

Circulating Iodoprotein in Two Patients with Autonomous Thyroid Nodules*

ABSTRACT Two euthyroid patients with autonomous thyroid nodules are presented in whom an abnormally large percentage of the circulating protein-bound Il3l-labeled material was not soluble in acid butanol. Chromatography and pancreatin digestion characterized this material as an iodoprotein. Electrophoresis showed that it migrated with the serum albumin. Subsequent electrophoresis of a saline extract of the nodule excised surgically from one of the patients showed an abnormally large amount of albumin-migrating iodoprotein. Since the scintigraphic studies clearly indicated that the nodule had completely suppressed the remainder of the gland, it is assumed that this circulating iodoprotein originated within the autonomous nodule.