Nodules are clonal or polyclonal and are due to heterogeneous responses of follicular epithelium to TSH Exophthalmos of Graves disease is not present Also called nodular hyperplasia Nontoxic goiter : no hyperthyroidism present Epidemiology 90% of those [pathologyoutlines.com]

Clinical presentation --------------------------------- MNG is seen more commonly in females (M:F=1:3) in the 35-50 years age range, who present with nodular enlargement in the midline of the neck. [youtube.com]

Session: Podium Presentation Program Number: S091 Post Views: 228 « Return to SAGES 2009 abstract archive [sages.org]

Patients who presented with compressive symptoms and no prior FNA at initial presentation were included in this study. [journals.aace.com]

Supine dyspnea was the presenting symptom in our patient, and the imaging studies excluded cardiac involvement. [rc.rcjournal.com]

• Thyroid Nodule

  Are you sure the patient has a thyroid nodule? Thyroid nodules are common and most often benign. However, 8-15% of all nodules can prove to be cancerous. There are ~50,000 new cases of thyroid cancer annually in the United States. [endocrinologyadvisor.com]

  thyroid nodule are euthyroid, but there is a high incidence of hypothyroidism or hyperthyroidism Patients with multiple thyroid nodules have the same overall risk of thyroid cancer as patients with solitary nodules The risk of a thyroid nodule being [accessmedicine.mhmedical.com]

  Thyroid ultrasonography is recommended in all patients with suspected thyroid nodules and for the initial evaluation of thyroid nodules discovered through other modalities. [empendium.com]

  Thyroid cancer presents as a thyroid nodule. [thyroid.org]

  Etiology Benign thyroid nodules ( ∼ 95% of cases) Thyroid adenomas Thyroid cysts Dominant nodules of multinodular goiters Hashimoto's thyroiditis Malignant thyroid nodules ( ∼ 5% of cases) Thyroid carcinoma Thyroid lymphoma Metastatic cancer from breast [amboss.com]

• Heat Intolerance

  Risk factors for toxic multinodular goiter include individuals over 60 years of age and being female. [4] Signs and symptoms [ edit ] Symptoms of toxic multinodular goitre are similar to that of hyperthyroidism, including: [4] heat intolerance muscle [en.wikipedia.org]

  Symptoms Symptoms may include any of the following: Fatigue Frequent bowel movements Heat intolerance Increased appetite Increased sweating Irregular menstrual period (in women) Muscle cramps Nervousness Restlessness Weight loss Older adults may have [account.allinahealth.org]

  Symptoms may include any of the following: Fatigue Frequent bowel movements Heat intolerance Increased appetite Increased sweating Irregular menstrual period (in women) Muscle cramps Nervousness Restlessness Weight loss Older adults may have symptoms [medlineplus.gov]

  Hyperthyroidism can result in weight loss, muscle weakness, heat intolerance, and anxiousness or irritability. [mayoclinic.org]

• Pathologist

  In addition, not all pathologists in our centre come through Australasian training and therefore some may not follow these guidelines. [nzma.org.nz]

  […] or high, then most individuals with a thyroid nodule larger than 1.0 to 1.5 cm (1/2 inch) in diameter as well as those with a suspicious goiter need to have a fine needle aspiration biopsy to obtain thyroid cells for cytologic evaluation by an expert pathologist [endocrinesurgery.ucsf.edu]

• Thyroid Lump

  If all the investigations are reassuring and the thyroid lump or swelling is not causing any problems, then no treatment may be required. Sometimes, the size of the lump may be monitored by follow-up scans. [btf-thyroid.org]

  Thyroid lumps and bumps. Aust Fam Physician 2007;36:531–6. Correspondence [email protected] [racgp.org.au]

• Hoarseness

  exposure to radioactive fallout as a child or teen Family history of thyroid cancer or a thyroid cancer syndrome (eg, Cowden syndrome, multiple endocrine neoplasia type 2, familial polyposis, Carney syndrome) Personal history of another malignancy Hoarseness [accessmedicine.mhmedical.com]

  Share on Pinterest Hoarseness and difficulty swallowing may be a symptom of a multinodular goiter. Multinodular goiters do not always cause symptoms. [medicalnewstoday.com]

  Important history includes how fast the thyroid is growing, risk factors for thyroid cancer (i.e. family history of cancer and history of radiation therapy to the neck or chest), family history of goiter, hoarseness, and symptoms of hyperthyroidism. [columbiasurgery.org]

  In this study, 4 patients developed hoarseness post surgery. Of the 4 patients, 3 recovered within 1 week and 1 recovered within 3 months. [medsci.org]

• Overeating

  There is also clear evidence of an increase with age, partly due to the fact that multinodular goitre is formed over a long period of time. Ultrasound examination of the thyroid gland will reveal nodules in about 50% of women aged 50 or over. [yourhormones.info]

  She had several nodules over 1 cm in size. A dominant left-sided 2.2-cm heterogeneous nodule was biopsied by fine needle aspiration two years before with a “benign” result. [healio.com]

  Figure 1: (a) Clinical photograph showing large soft tissue swelling over scalp. (Arrow), (b) X-ray skull lateral view showing lytic lesion over skull. [ijem.in]

  There are a number of different guidelines as to which nodules should be biopsied, but in general, nodules over 1 cm should be biopsied. [columbiasurgery.org]

  […] goiters can cause dyspnea due to tracheal compression Large substernal goiters may cause superior vena cava syndrome, manifested by facial erythema and jugular vein distention that progress to cyanosis and facial edema when both arms are kept raised over [accessmedicine.mhmedical.com]

• Hypertension

  The patient is a known case of hypertension for 9 years and was on regular medication. The patient had hysterectomy done under spinal anesthesia 8 years back. On examination, the patient was obese (body weight - 90 kg). [aeronline.org]

  Three patients who did not show signs or symptoms of hyperthyroidism were already taking ß-blockers as part of their anti-hypertensive treatment. [scielo.br]

  One study reported the successful management of pulmonary hypertension and heart failure caused by long-standing substernal goiter by performing a thyroidectomy ( 27 ). [liebertpub.com]

• Osteoporosis

  Her PHPT was complicated by osteoporosis and recurrent urolithiasis. Cervical ultrasonography and thyroid scintigraphy affirmed the presence of TMNG and bilateral lower parathyroid adenoma. [endocrine-abstracts.org]

  Further investigations - selected cases only Bone densitometry Bone mineral density should be assessed where there is clinical suspicion of osteoporosis, for example in some older patients with biochemical thyrotoxicosis. [endobible.com]

  […] years of age and being female. [4] Signs and symptoms [ edit ] Symptoms of toxic multinodular goitre are similar to that of hyperthyroidism, including: [4] heat intolerance muscle weakness/wasting hyperactivity fatigue tremor irritability weight loss osteoporosis [en.wikipedia.org]

  Treatment of a goiter with thyroxine has questionable positive value and puts the patient at considerable risk for the problems of hyperthyroidism such as cardiac dysrhythmias and especially osteoporosis. [mdedge.com]

  Possible Complications Heart complications: Heart failure Irregular heartbeat ( atrial fibrillation ) Rapid heart rate Other complications: Bone loss leading to osteoporosis Thyroid crisis or storm is an acute worsening of hyperthyroidism symptoms. [account.allinahealth.org]

• Muscle Weakness

  Symptoms of this thyroid condition include muscle weakness, a rapid heartbeat, weight loss, irritability, vision problems, and infertility. Hyperthyroidism can be caused by thyroid nodules, or lumps on the thyroid gland. [diabetesandmetabolism.com]

  Hyperthyroidism can result in weight loss, muscle weakness, heat intolerance, and anxiousness or irritability. [mayoclinic.org]

  Risk factors for toxic multinodular goiter include individuals over 60 years of age and being female. [4] Signs and symptoms [ edit ] Symptoms of toxic multinodular goitre are similar to that of hyperthyroidism, including: [4] heat intolerance muscle [en.wikipedia.org]

• Sweating

  Calling your health care provider: Call your health care provider if signs of thyrotoxicosis develop: Fever Increased pulse rate Palpitations Diarrhea or constipation Nausea Fatigue Dry Skin Sweating Tremors Anxiety Shortness of breath Prevention: Use [uclahealth.org]

  Symptoms Symptoms may include any of the following: Fatigue Frequent bowel movements Heat intolerance Increased appetite Increased sweating Irregular menstrual period (in women) Muscle cramps Nervousness Restlessness Weight loss Older adults may have [account.allinahealth.org]

  Symptoms may include any of the following: Fatigue Frequent bowel movements Heat intolerance Increased appetite Increased sweating Irregular menstrual period (in women) Muscle cramps Nervousness Restlessness Weight loss Older adults may have symptoms [medlineplus.gov]

  These include: sudden and unexplained weight loss rapid heartbeat increased appetite nervousness or anxiety tremors, usually in your hands sweating increased sensitivity to heat A multinodular goiter that grows large can also cause symptoms, especially [healthline.com]

• Increased Sweating

  Symptoms Symptoms may include any of the following: Fatigue Frequent bowel movements Heat intolerance Increased appetite Increased sweating Irregular menstrual period (in women) Muscle cramps Nervousness Restlessness Weight loss Older adults may have [account.allinahealth.org]

  Symptoms may include any of the following: Fatigue Frequent bowel movements Heat intolerance Increased appetite Increased sweating Irregular menstrual period (in women) Muscle cramps Nervousness Restlessness Weight loss Older adults may have symptoms [medlineplus.gov]

  The extra thyroxine can cause symptoms of an overproduction of thyroid hormones (hyperthyroidism), such as: Unexplained weight loss Increased sweating Tremor Nervousness Rapid or irregular heartbeat Only a small number of thyroid nodules are cancerous [mayoclinic.org]

• Dizziness

  Symptoms: Thyroid enlargement -- may vary from a single small nodule to massive enlargement Breathing difficulties from compression of the trachea (rare) Swallowing difficulties from compression of the esophagus (rare) Neck vein distention and dizziness [uclahealth.org]

If any changes occur, then further workup is indicated. Evidence-based answers from the Family Physicians Inquiries Network [mdedge.com]

[…] and pelvis (23%), however, such lesions in the long bones and skull are less common (6% each [4] Multiple bone site involvement at a given time is also quite frequent (40%), as seen in our patient. [7] Patients with metastatic disease need a complete workup [ijem.in]

Treatment and prognosis ----------------------------------------- Treatment of multinodular goitre may be pursued if the thyroid is hyperfunctioning, or if the goitre is causing local mass effect. [youtube.com]

Three of these 8 patients had 1 131 I treatment, 4 patients had 2 treatments, and 1 patient had 3 treatments. These patients did not want subsequent 131 I treatment and were given long-term antithyroid drug treatment. [jamanetwork.com]

In such instances, surgical treatment or radioactive iodine treatment (also known as radioiodine ) may be considered for a more permanent treatment of overactive thyroid. [yourhormones.info]

Treatment and prognosis ----------------------------------------- Treatment of multinodular goitre may be pursued if the thyroid is hyperfunctioning, or if the goitre is causing local mass effect. [youtube.com]

The type of cancer (PTC or FTC) was not a significant indicator of prognosis. [ijem.in]

Expectations (prognosis): The prognosis is good with treatment. A persistent goiter may become toxic, causing symptoms of excess thyroid hormones to develop. [uclahealth.org]

[…] but may be seen incidentally CT may be useful for fully characterizing the extent of substernal (retrosternal) goiter an enlarged and heterogeneous thyroid gland suggests the diagnosis, which is confirmed by ultrasound or scintigraphy Treatment and prognosis [radiopaedia.org]

Other tests that may be done include: Serum thyroid hormone levels ( T3, T4 ) Serum TSH (thyroid stimulating hormone) Thyroid uptake and scan or radioactive iodine uptake Thyroid ultrasound Outlook (Prognosis) Toxic nodular goiter is mainly a disease [account.allinahealth.org]

Treatment depends on the underlying etiology and includes, e.g., surgery ( thyroidectomy ) for malignant and autonomous nodules, fine needle aspiration for thyroid cysts, and observation for small, benign nodules. [amboss.com]

The etiology of nontoxic MNG is multifactorial, with the important factors including, among others, iodine deficiency (initially manifesting as a simple goiter), genetic predisposition, goitrogens, exposure to ionizing radiation, and history of thyroiditis [empendium.com]

However, the true etiology of most nontoxic goiters in iodine-sufficient areas is unknown. Symptoms and Signs The patient may have a history of low iodine intake or overingestion of food goitrogens, but these phenomena are rare in North America. [merckmanuals.com]

Medline, CAS, Google Scholar 17 Diez JJ: Goiter in adult patients aged 55 years and older: etiology and clinical features in 634 patients. J. [futuremedicine.com]

[…] follicular epithelium to TSH Exophthalmos of Graves disease is not present Also called nodular hyperplasia Nontoxic goiter : no hyperthyroidism present Epidemiology 90% of those affected are women Develops more frequently during adolescence and pregnancy Etiology [pathologyoutlines.com]

Epidemiology References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Wang, C, Crapo, LM The epidemiology of thyroid disease and implications for screening. Endocrinol Metab Clin North Am 1997 ;26: 189 – 218. Google Scholar | Crossref | Medline | ISI 2. [journals.sagepub.com]

Goiter prevalence and thyroid abnormalities at ultrasonography: a complete epidemiological study in two regions with slightly different iodine status. Clin. Endocrinol. 53,479–485 ( 2000 ). [futuremedicine.com]

[…] dominant nodule is present Nodules are clonal or polyclonal and are due to heterogeneous responses of follicular epithelium to TSH Exophthalmos of Graves disease is not present Also called nodular hyperplasia Nontoxic goiter : no hyperthyroidism present Epidemiology [pathologyoutlines.com]

[…] either FNA (based on sonographic criteria) or monitoring (with repeat ultrasounds) if criteria are not met Sonographic criteria for fine-needle aspiration ( FNA ) References: [1] [3] Follicular adenoma Toxic adenoma Toxic multinodular goiter Epidemiology Pathophysiology [amboss.com]

Pathophysiology Toxic nodular goiter (TNG) represents a spectrum of disease ranging from a single hyperfunctioning nodule (toxic adenoma) within a multinodular thyroid to a gland with multiple areas of hyperfunction. [emedicine.medscape.com]

prevent tracheomalacia and extubated her after 36 h after performing leak test. [aeronline.org]

The routine use of iodized table salt now helps prevent this deficiency. Risk factors are being female, being older than 40, having an inadequate dietary intake of iodine, living in an endemic area, and having a family history of goiters. [uclahealth.org]

Prevention To prevent toxic nodular goiter, treat hyperthyroidism and simple goiter as your provider suggests. [account.allinahealth.org]

Large goiters occasionally require surgery or iodine-131 to shrink the gland enough to prevent interference with respiration or swallowing or to correct cosmetic problems. Thyroid function is usually normal. [merckmanuals.com]

Repas is the former chairman of the professional diabetes advisory committees of the Wyoming and the Wisconsin Diabetes Prevention and Control Programs. [healio.com]