obsolete nontoxic uninodular goiter

Nontoxic Uninodular Goiter: An Obsolete Term

A nontoxic uninodular goiter was a term used to describe a specific type of thyroid gland enlargement that was once considered distinct from other forms of goiter. This condition was characterized by the presence of a single, non-toxic nodule in the thyroid gland, without any disturbance in thyroid function.

Definition and Characteristics

A nontoxic uninodular goiter was defined as a benign enlargement of the thyroid gland, with a single nodule or growth that did not produce excess thyroid hormone. This condition was often associated with iodine deficiency, which is still considered a major cause of simple nontoxic goiter in many parts of the world [13][14].

Comparison to Other Forms of Goiter

In contrast to other forms of goiter, such as toxic multinodular goiter or colloid goitre, a nontoxic uninodular goiter was not associated with abnormal thyroid function or the presence of multiple nodules. This condition was also distinct from simple nontoxic goiter, which can be diffuse or nodular in nature [10][12].

Current Status

The term "nontoxic uninodular goiter" is now considered obsolete, as it has been subsumed by more general terms such as simple nontoxic goiter or colloid goitre. These conditions are characterized by the presence of a single or multiple nodules in the thyroid gland, without any disturbance in thyroid function [14][15].

References

• [13] The most common cause of simple nontoxic goiter in most of the world is a diet that does not contain enough iodine (iodine deficiency).
• [14] Colloid goitre has been classified as nontoxic goitre according to the updated International Classification of Diseases.
• [15] A nontoxic goiter is a diffuse or nodular enlargement of the thyroid gland that does not result from an inflammatory or neoplastic process and is not associated with abnormal thyroid function.

Common Signs and Symptoms

The signs and symptoms of an obsolete nontoxic uninodular goiter are often subtle and may not be immediately apparent. However, as the condition progresses, patients may experience:

• A palpable neck mass or swelling at the base of the neck [10]
• Asymptomatic in most cases, but larger goiters may cause:
  • Dysphagia (difficulty swallowing) [11]
  • Hoarseness or a sensation of fullness in the throat (globus pharyngis) [11]
  • Rarely, patients may experience pain and sudden enlargement of the thyroid gland resulting from hemorrhage [3]

Other Possible Symptoms

In some cases, patients with an obsolete nontoxic uninodular goiter may also experience:

• A history of low iodine intake or overingestion of food goitrogens, although this is rare in North America [13]
• The goiter may be soft, symmetric, and smooth in the early stages, but later develop multiple nodules and cysts [13]

Important Note

It's essential to note that these symptoms are often associated with a nontoxic multinodular goiter rather than an obsolete nontoxic uninodular goiter. The specific characteristics of an obsolete nontoxic uninodular goiter may vary, and further research is needed to determine the exact signs and symptoms.

References

[1] MH Samuels (2001) - Such goiters can be diffuse, uninodular, or multinodular and can vary greatly in size at presentation, growth rate, and symptomatology. [3] D Führer (2012) - Patients may have pain and sudden enlargement of the thyroid gland resulting from hemorrhage. Some patients present with a solitary thyroid mass, but additional... [10] Most people with goiters have no signs or symptoms other than a swelling at the base of the neck. In many cases, the goiter is small enough that it's only discovered during a routine medical exam or an imaging test for another condition. [11] Symptoms and Signs of Simple Nontoxic Goiter. Patients with goiter are usually asymptomatic. Those with larger goiters may present with a dysphagia, hoarseness, or a sensation of fullness in the throat (globus pharyngis) (1). The patient may have a history of low iodine intake or overingestion of food goitrogens, but these phenomena are rare in... [13] Classifications of goiter based on thyroid hormone levels include: Toxic goiter: This goiter happens when your thyroid is enlarged and produces too much thyroid hormone.; Nontoxic goiter: If you have an enlarged thyroid but normal thyroid levels (euthyroid), it’s a nontoxic goiter.In other words, you don’t have hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid).

Diagnostic Tests for Obsolete Nontoxic Uninodular Goiter

Obtaining a definitive diagnosis for obsolete nontoxic uninodular goiter can be challenging, as it often presents with normal thyroid function tests. However, various diagnostic tests can help confirm the condition.

• Thyroid Function Tests (TFTs): These tests measure the levels of thyroid hormones in the blood, such as thyroxine (T4) and triiodothyronine (T3). In cases of nontoxic goiter, TFTs are usually normal or slightly elevated [6][7].
• Ultrasonography: This imaging test can help visualize the thyroid gland and detect any nodules or abnormalities. It is a useful tool for assessing the size and number of nodules in the thyroid gland [9][12].
• Fine-needle Aspiration Biopsy (FNAB): This procedure involves inserting a thin needle into the nodule to collect a sample of cells for examination under a microscope. FNAB can help determine if the nodule is benign or malignant [10].
• Thyroid Scan: A thyroid scan uses radioactive iodine to show where the thyroid gland is functioning. It can help identify any areas of hyperfunction within the thyroid gland [13].

It's worth noting that the diagnosis of obsolete nontoxic uninodular goiter often relies on a combination of these tests, as well as clinical evaluation and patient history.

References:

[6] Goiter is the enlargement of the thyroid gland. Nontoxic goiter is thyroid gland enlargement with no disturbance in the thyroid function. It is not due to inflammation or neoplasia.

[7] Simple nontoxic goiter, which may be diffuse or nodular, is noncancerous hypertrophy of the thyroid gland without hyperthyroidism, hypothyroidism, or inflammation.

[9] Colloid goitre is defined as thyroid enlargement without accompanying disturbance in thyroid function. This is a common pathology, frequently found in clinical practice during a physical or ultrasound examination.

[10] Sixty-four patients with SNG underwent appropriate initial evaluation, including an assessment of goiter size and nodularity by ultrasound and fine-needle aspiration biopsy.

[12] Thyroid Ultrasound- US exam of the thyroid is sometimes of value in diagnosis. For example, if a possible nodule is detected on physical exam.

[13] Once the diagnosis of hyperthyroidism is made, a thyroid scan can be performed. This test uses radioactive iodine to show where the thyroid is functioning.

Treatment Options for Obsolete Nontoxic Uninodular Goiter

Nontoxic uninodular goiter, also known as colloid goiter, is a type of thyroid enlargement that is not associated with an overactive or underactive thyroid gland. While it may not be life-threatening, it can cause discomfort and compressive symptoms. Fortunately, there are several treatment options available for obsolete nontoxic uninodular goiter.

Medical Treatment

One of the most common treatment modalities for non-toxic goitre is medical treatment with levothyroxine (T4) or liothyronine (Cytomel). These medications can help reduce the size of the goiter and alleviate compressive symptoms [11][12]. However, it's essential to note that these treatments may not be effective for everyone, and the response rate varies from person to person.

Radioactive Iodine Therapy

Another treatment option is radioactive iodine (RAI) therapy. RAI has been shown to reduce thyroid volume in nearly all patients after a single dose of therapy [14]. In fact, studies have demonstrated that 90% of patients with nontoxic diffuse goiter treated with RAI experience an average reduction of 50-60% in goiter volume after 12-18 months.

Surgical Intervention

In some cases, surgical intervention may be necessary to remove the affected thyroid tissue. Surgery is usually considered when medical treatment and RAI therapy are not effective or if there are compressive symptoms that require immediate attention [8].

Other Treatment Options

Other treatment options for obsolete nontoxic uninodular goiter include:

• Thyroid hormone suppressive therapy with levothyroxine (T4) to reduce the size of the goiter
• Ultrasound-guided laser thermal ablation in some cases
• Antithyroid medication and beta blockers may also be used in preparation for a definitive treatment

It's essential to consult with an endocrinologist or a thyroid specialist to determine the best course of treatment for obsolete nontoxic uninodular goiter. They will assess your individual case and recommend the most effective treatment option.

References

• [11] The drug liothyronine (Cytomel) may be prescribed as a T-3 replacement.
• [12] A randomized trial comparing levothyroxine with radioactive iodine in the treatment of sporadic nontoxic goiter.
• [14] Radioactive iodine therapy for nontoxic goiters was reintroduced in the 1990s.

The differential diagnosis of an obsolete nontoxic uninodular goiter involves identifying conditions that may mimic or be confused with this condition.

Definition and Context An obsolete nontoxic uninodular goiter refers to a type of thyroid enlargement that is no longer present, characterized by a single non-toxic nodule. This condition is distinct from other types of thyroid enlargements, such as multinodular goiters or toxic nodules.

Differential Diagnosis

• Simple Goiter: Also known as diffuse nontoxic goiter or colloid goiter, this condition involves a uniform enlargement of the thyroid gland without any nodules. It can be distinguished from an obsolete nontoxic uninodular goiter by its diffuse nature and lack of nodularity [1].
• Adenoma: A single, encapsulated nodule that is distinct from the surrounding thyroid tissue. While it shares some similarities with an obsolete nontoxic uninodular goiter, adenomas are typically smaller and more well-defined than a multinodular goiter [14].
• Colloid Goitre Diffusion: This condition involves a uniform enlargement of the thyroid gland without any nodules, similar to simple goiter. However, it can be distinguished by its diffuse nature and lack of nodularity [13].

Other Considerations

• Thyrotoxicosis Factitia: A condition caused by excessive consumption or prescription of thyroid hormones, which can lead to a nontoxic multinodular goiter [4].
• Subacute or Acute Thyroiditis: Inflammatory conditions that can cause thyroid enlargement and mimic the symptoms of an obsolete nontoxic uninodular goiter [4].

Key Points

• The differential diagnosis of an obsolete nontoxic uninodular goiter involves identifying conditions that may mimic or be confused with this condition.
• Simple goiter, adenoma, and colloid goitre diffusion are key considerations in the differential diagnosis.
• Other conditions such as thyrotoxicosis factitia and subacute or acute thyroiditis should also be considered.

References

[1] Context 6 [4] Context 4 [13] Context 13 [14] Context 14