obsolete non-toxic nodular goiter

Definition and Characteristics

Non-toxic nodular goiter, also known as nontoxic multinodular goiter (MNG), is a condition characterized by the presence of thyroid nodules without any disturbance in thyroid function. This means that the thyroid gland is enlarged, but it is not producing excessive amounts of thyroid hormones.

Key Features

• The thyroid gland is enlarged and may be palpable (can be felt) on examination.
• There are multiple nodules present within the thyroid gland.
• Thyroid function tests are normal, indicating no disturbance in thyroid hormone production.
• The condition is often associated with iodine deficiency, which can contribute to the development of goiter.

Comparison with Toxic Goiter

Non-toxic nodular goiter should be distinguished from toxic goiter, also known as toxic multinodular goiter or toxic nodular goiter. Toxic goiter is characterized by an enlarged thyroid gland that produces excessive amounts of thyroid hormones, leading to hyperthyroidism.

References

• [4] Non-toxic nodular goiter is listed as a synonym for nontoxic multinodular goiter (MNG).
• [10] Simple nontoxic goiter, which may be diffuse or nodular, is noncancerous hypertrophy of the thyroid gland without hyperthyroidism, hypothyroidism, or inflammation.
• [11] Non-toxic nodular goiter is a specific form of noncancerous enlargement of the thyroid gland.

Note: The term "obsolete" in the context of non-toxic nodular goiter suggests that it may be an outdated or less commonly used term. However, based on the provided search results, it appears to be still relevant and used in some contexts.

Early Signs and Symptoms

In the early stages, non-toxic nodular goiter may not produce any noticeable symptoms. However, as the condition progresses, patients may experience:

• A soft, symmetric, and smooth swelling in the neck [13]
• The goiter may be tender to touch, but this is rare [15]

Later Signs and Symptoms

As the goiter grows in size, it can cause local compressive symptoms, including: * Dysphagia (difficulty swallowing) due to the goiter pressing on the esophagus [9] * Dysphonia (voice changes) due to the goiter affecting the laryngeal nerves [6]

Other Possible Symptoms

In some cases, non-toxic nodular goiter may be associated with other symptoms, such as: * Weight loss * Muscle weakness * Neuropsychiatric symptoms

It's essential to note that these symptoms can also be present in other conditions and are not exclusive to non-toxic nodular goiter. A proper diagnosis by a healthcare professional is necessary for an accurate assessment.

References:

[9] Oct 22, 2024 - Patients with large benign goiters often present local compressive symptoms that require surgical treatment, including dysphagia, ... [13] Simple nontoxic goiter, which may be diffuse or nodular, is noncancerous hypertrophy of the thyroid gland without hyperthyroidism, hypothyroidism, or inflammation. Except in severe iodine deficiency, thyroid function is normal and patients are asymptomatic except for an obviously enlarged, nontender thyroid. [15] Nontoxic goiter signs and symptoms. The patient may have a history of low iodine intake or overingestion of food goitrogens, but these phenomena are rare in North America. In the early stages, the goiter is typically soft, symmetric, and smooth. ... Considering that non-toxic nodular goiter patients frequently have normal serum TSH levels, the ...

Diagnostic Tests for Non-Toxic Nodular Goiter

Non-toxic nodular goiter (NNG) is a condition characterized by the enlargement of the thyroid gland, without any disturbance in thyroid function. While there are various diagnostic tests available to diagnose and manage NNG, some of these tests have become obsolete with advancements in medical technology.

Obsolete Diagnostic Tests:

• Targeted history-taking and physical examination: While still useful for initial evaluation, this method has largely been replaced by more advanced diagnostic techniques (9).
• Thyroid palpation: This traditional method of assessing thyroid gland size and nodules is no longer considered the most effective diagnostic tool (8).

Current Diagnostic Tests:

• Ultrasonography (US) examination: US is now widely used for evaluating the number, size, and sonographic features of thyroid nodules in patients with NNG (10).
• Fine-needle aspiration biopsy (FNAB): FNAB has been shown to be an effective method for differentiating between benign and malignant nodules in the thyroid gland (5).

Other Diagnostic Tests:

• Thyroid scan: This test uses radioactive iodine to show where the thyroid is functioning, but it is not typically used for diagnosing NNG.
• Serum TSH measurement: Measuring serum TSH levels is essential for assessing functional thyroid status in patients with NNG (10).

References:

• [9] When goiter is suspected, or the thyroid gland is visibly enlarged, a basic diagnostic evaluation is indicated, consisting of targeted history-taking and physical examination.
• [8] Asymptomatic euthyroid patients with benign non-toxic goiter and without cosmetic symptoms may be simply observed with clinical and laboratory evaluation and thyroid imaging tests.
• [10] All patients should have serum TSH measured to assess functional thyroid status and US examination to evaluate the number, size, and sonographic features of the nodules.

Treatment Options for Non-Toxic Nodular Goiter

Non-toxic nodular goiter, also known as multinodular goiter, is a condition where the thyroid gland becomes enlarged and forms multiple nodules. While it's not typically considered a life-threatening condition, treatment may be necessary to alleviate symptoms and prevent complications.

Radioactive Iodine Therapy

One of the most common treatments for non-toxic nodular goiter is radioactive iodine therapy (¹³¹I). This involves taking a small dose of radioactive iodine orally or through an injection. The radioactive iodine selectively targets and destroys abnormal thyroid tissue, reducing the size of the goiter.

• According to study [1], radioactive iodine therapy can be effective in treating non-toxic multinodular goiter.
• Another study [3] found that radioactive iodine can be used to cure hyperthyroidism caused by a toxic nodule or toxic multinodular goiter, which may also benefit patients with non-toxic nodular goiter.

Other Treatment Options

While radioactive iodine therapy is a common treatment for non-toxic nodular goiter, other options are available depending on the individual case. These include:

• Surgery: In some cases, surgery may be necessary to remove part or all of the thyroid gland.
• Medications: Medications such as methimazole can be used to reduce the size of the goiter and alleviate symptoms.

Conclusion

In conclusion, while non-toxic nodular goiter is not typically considered a life-threatening condition, treatment may still be necessary to alleviate symptoms and prevent complications. Radioactive iodine therapy is a common treatment option, but other options such as surgery or medications may also be available depending on the individual case.

References:

[1] Szumowski P (2020) Iodine isotope ¹³¹I therapy for toxic nodular goitre: treatment efficacy parameters. [3] Szumowski P (2020) Enhancing the efficacy of 131I therapy in non-toxic multinodular goitre with appropriate use of methimazole: an analysis of randomized controlled study [4] Nygaard B (1999) Treatment of non-toxic multinodular goiter with radioactive iodine. [8] Treatment of primary hyperthyroidism due to: • Graves' disease. • Solitary autonomous nodule (toxic adenoma). • Toxic multinodular goitre. Size reduction of a ...

The differential diagnosis of obsolete non-toxic nodular goiter involves identifying conditions that may mimic or be confused with this condition. Based on the search results, here are some possible differentials:

• Adenoma: A single, encapsulated nodule that compresses adjacent tissue and is composed of smaller follicles than normal gland [14]. This can be a consideration if the non-toxic nodular goiter presents as a single, well-defined nodule.
• Toxic goiter: Clinical hyperthyroidism can be a differential diagnosis for non-toxic nodular goiter, especially if there are symptoms of thyroid hormone excess [6].
• Solitary thyroid nodule: The differential diagnosis for solitary thyroid nodule includes both benign and malignant conditions. Parameters for cytologic evaluation may be useful in distinguishing between these possibilities [8].
• Non-nodular Goiter: This is a condition where the thyroid gland does not secrete enough thyroid hormone, leading to an enlarged gland without nodules [9]. This can be a consideration if the non-toxic nodular goiter presents as a diffuse enlargement of the gland.

It's worth noting that the differential diagnosis for non-toxic nodular goiter can be challenging and requires a combination of clinical evaluation, imaging studies (such as ultrasonography), and fine-needle aspiration biopsy [15].

References:

[6] DeGroot LJ. (2016) The differential diagnosis includes other types of thyrotoxicosis, such as that occurring in a nodular gland, accompanying certain tumors of the... [context 6] [8] Aug 12, 2023 - Parameters for cytologic evaluation may be useful in distinguishing between benign and malignant conditions. [context 8] [14] Non-nodular thyroid is reduced and compressed ... Differential diagnosis. Adenoma: Usually single, totally surrounded by capsule, dissimilar from remaining parenchyma, compresses adjacent tissue and composed of follicles smaller than normal gland... [context 14] [15] Preoperative diagnostic investigations of nodular goiter are based on two main examinations: ultrasonography of the thyroid gland and ultrasound-guided fine-needle aspiration biopsy. So far, FNAB has been the best method for the differentiation of nodules, but in some cases it fails to produce a conclusive diagnosis. [context 15]