Toxic multinodular goiter natural history, complications and prognosis: Difference between revisions
Jump to navigation
Jump to search
Usama Talib (talk | contribs) No edit summary |
|||
| (20 intermediate revisions by one other user not shown) | |||
| Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
{{Toxic multinodular goiter}} | {{Toxic multinodular goiter}} | ||
{{CMG}}; {{AE}}{{Akshun}} | |||
==Overview== | |||
If left untreated, toxic multinodular goiter may progress to develop [[hyperthyroidism]]. However, the progression of toxic multinodular goiter is quite slow. Untreated patients initially have a history of [[thyroid]] enlargement followed by a long period of subclinical [[hyperthyroidism]]. Overt hyperthyroidism occurs late in the course of toxic multinodular goiter. Common [[complications]] of toxic multinodular goiter include [[tachycardia]], [[arrhythmia]], [[atrial fibrillation]], [[heart failure]] ([[dilated cardiomyopathy]]), [[pulmonary hypertension]], facial [[plethora]], inspiratory [[stridor]], [[hoarseness]], [[dysphagia]], [[osteoporosis|bone mineral loss]] and [[thyroid storm]]. Prognosis of toxic multinodular goiter is generally good with treatment. Both [[surgery]] and [[radioactive iodine]] therapy can confer a moderate long-term risk of [[hypothyroidism]] and such patients require lifelong [[hormone]] replacement [[therapy]]. Toxic multinodular goiter is commonly seen in elderly. Therefore, in elderly, presence of other conditions may influence the outcome of toxic multinodular goiter. | |||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
*The | *If left untreated, toxic multinodular goiter may progress to develop [[hyperthyroidism]].<ref name="pmid582300">{{cite journal |vauthors=Wiener JD, de Vries AA |title=On the natural history of Plummer's disease |journal=Clin Nucl Med |volume=4 |issue=5 |pages=181–90 |year=1979 |pmid=582300 |doi= |url=}}</ref><ref name="pmid2114018">{{cite journal |vauthors=Elte JW, Bussemaker JK, Haak A |title=The natural history of euthyroid multinodular goitre |journal=Postgrad Med J |volume=66 |issue=773 |pages=186–90 |year=1990 |pmid=2114018 |pmc=2429462 |doi= |url=}}</ref><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> | ||
* | *Untreated toxic multinodular goiter progresses slowly and initially presents with history of [[thyroid]] enlargement. | ||
* | *[[Thyroid]] enlargement is followed by a long period of subclinical hyperthyroidism. | ||
*Overt [[hyperthyroidism]] occurs late in the course of toxic multinodular goiter. | |||
**When [[hyperthyroidism]] is present, cardiac symptoms are the most common presentation such as [[palpitations]], [[tachycardia]], [[heart failure]] and [[atrial fibrillation]]. | |||
** Over the course of time, toxic multinodular goiter may increase in size and can lead to compression of surrounding structures such as [[trachea]], [[esophagus]] or [[external jugular vein]]. | |||
===Complications=== | ===Complications=== | ||
Common complications of toxic multinodular goiter include:<ref name="pmid18752767">{{cite journal |vauthors=Dahl P, Danzi S, Klein I |title=Thyrotoxic cardiac disease |journal=Curr Heart Fail Rep |volume=5 |issue=3 |pages=170–6 |year=2008 |pmid=18752767 |doi= |url=}}</ref><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> | |||
**[ | *[[Tachycardia]] | ||
**[ | *[[Arrhythmia]] | ||
**[ | *[[Atrial fibrillation]] | ||
*[[Heart failure]] ([[dilated cardiomyopathy]]) | |||
*[[Pulmonary hypertension]] | |||
*Facial [[plethora]] | |||
*Inspiratory [[stridor]] | |||
*[[Hoarseness]] | |||
*[[Dysphagia]] | |||
*[[Osteoporosis|Bone mineral loss]] | |||
*[[Thyroid storm]] | |||
*[[Iodine-131|I-131]]-related hypothyroidism | |||
*Surgery-related | |||
**[[Hypothyroidism]] | |||
**Recurrent [[Laryngeal nerve palsy|laryngeal nerve damage]] | |||
**[[Hypoparathyroidism]] | |||
===Prognosis=== | ===Prognosis=== | ||
*Prognosis is generally | *Prognosis of toxic multinodular goiter is generally good with treatment. | ||
* | *About 45% to 75% of patients stay [[euthyroid]] following [[I-123 thyroid imaging|I-131]] therapy. | ||
* | *Both surgery and [[radioactive iodine]] therapy can confer a moderate long-term risk of [[hypothyroidism]]. | ||
* | *Patients with [[I-123 thyroid imaging|I-131]] therapy who develop hypothyroidism require lifelong thyroid hormone replacement therapy | ||
*Toxic multinodular goiter is commonly seen in elderly. Therefore, in elderly, presence of other conditions may influence the outcome of toxic multinodular goiter. | |||
==References== | ==References== | ||
Latest revision as of 12:16, 17 October 2017
|
Toxic multinodular goiter Microchapters |
|
Differentiating Toxic multinodular goiter from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Toxic multinodular goiter natural history, complications and prognosis On the Web |
|
American Roentgen Ray Society Images of Toxic multinodular goiter natural history, complications and prognosis |
|
FDA on Toxic multinodular goiter natural history, complications and prognosis |
|
CDC on Toxic multinodular goiter natural history, complications and prognosis |
|
Toxic multinodular goiter natural history, complications and prognosis in the news |
|
Blogs on Toxic multinodular goiter natural history, complications and prognosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]
Overview
If left untreated, toxic multinodular goiter may progress to develop hyperthyroidism. However, the progression of toxic multinodular goiter is quite slow. Untreated patients initially have a history of thyroid enlargement followed by a long period of subclinical hyperthyroidism. Overt hyperthyroidism occurs late in the course of toxic multinodular goiter. Common complications of toxic multinodular goiter include tachycardia, arrhythmia, atrial fibrillation, heart failure (dilated cardiomyopathy), pulmonary hypertension, facial plethora, inspiratory stridor, hoarseness, dysphagia, bone mineral loss and thyroid storm. Prognosis of toxic multinodular goiter is generally good with treatment. Both surgery and radioactive iodine therapy can confer a moderate long-term risk of hypothyroidism and such patients require lifelong hormone replacement therapy. Toxic multinodular goiter is commonly seen in elderly. Therefore, in elderly, presence of other conditions may influence the outcome of toxic multinodular goiter.
Natural History, Complications, and Prognosis
Natural History
- If left untreated, toxic multinodular goiter may progress to develop hyperthyroidism.[1][2][3][4]
- Untreated toxic multinodular goiter progresses slowly and initially presents with history of thyroid enlargement.
- Thyroid enlargement is followed by a long period of subclinical hyperthyroidism.
- Overt hyperthyroidism occurs late in the course of toxic multinodular goiter.
- When hyperthyroidism is present, cardiac symptoms are the most common presentation such as palpitations, tachycardia, heart failure and atrial fibrillation.
- Over the course of time, toxic multinodular goiter may increase in size and can lead to compression of surrounding structures such as trachea, esophagus or external jugular vein.
Complications
Common complications of toxic multinodular goiter include:[5][6]
- Tachycardia
- Arrhythmia
- Atrial fibrillation
- Heart failure (dilated cardiomyopathy)
- Pulmonary hypertension
- Facial plethora
- Inspiratory stridor
- Hoarseness
- Dysphagia
- Bone mineral loss
- Thyroid storm
- I-131-related hypothyroidism
- Surgery-related
Prognosis
- Prognosis of toxic multinodular goiter 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.
- Patients with I-131 therapy who develop hypothyroidism require lifelong thyroid hormone replacement therapy
- Toxic multinodular goiter is commonly seen in elderly. Therefore, in elderly, presence of other conditions may influence the outcome of toxic multinodular goiter.
References
- ↑ Wiener JD, de Vries AA (1979). "On the natural history of Plummer's disease". Clin Nucl Med. 4 (5): 181–90. PMID 582300.
- ↑ Elte JW, Bussemaker JK, Haak A (1990). "The natural history of euthyroid multinodular goitre". Postgrad Med J. 66 (773): 186–90. PMC 2429462. PMID 2114018.
- ↑ 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.
- ↑ Dahl P, Danzi S, Klein I (2008). "Thyrotoxic cardiac disease". Curr Heart Fail Rep. 5 (3): 170–6. PMID 18752767.
- ↑ 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.