obsolete nontoxic multinodular goiter

Obsolescence of Nontoxic Multinodular Goiter

Nontoxic multinodular goiter (MNG) is a condition characterized by the enlargement of the thyroid gland due to multiple nodules, without any changes in thyroid hormone levels. However, with advancements in medical science and treatment options, this condition has become less relevant.

Historical Context In the past, nontoxic MNG was a common diagnosis, particularly in regions where iodine deficiency was prevalent [1]. The incidence of multinodular goiter in elderly populations may have increased up to 10% in areas where iodine deficiency was subsequently solved [1].

Current Treatment Options With the availability of modern treatment options, such as thyroid scintigraphy and radioactive iodine therapy (131I), nontoxic MNG is no longer a significant concern. Radioactive iodine therapy has been shown to reduce the volume of non-toxic nodular goiters by 35-50% within one year [6].

Shift in Focus The focus in thyroid medicine has shifted towards more pressing concerns, such as cancer and infection, which can also present with multinodular goiter. As a result, nontoxic MNG is now considered an obsolete condition.

References:

[1] Context 1 [6] Context 6

Common Signs and Symptoms

Patients with an obsolete nontoxic multinodular goiter are usually asymptomatic, but those with larger goiters may experience some symptoms. These can include:

• Dysphagia (difficulty swallowing) [1]
• Hoarseness or a change in voice quality
• A sensation of fullness in the throat (globus pharyngis)
• Mild pain or eye discomfort
• Lacrimation (tearing)
• Photophobia (sensitivity to light)
• Blurring of vision
• Diplopia (double vision)

These symptoms are often related to the size of the goiter and can vary greatly in severity. In some cases, patients may also experience a history of low iodine intake or overingestion of food goitrogens, but these phenomena are rare.

Other Possible Symptoms

In addition to the above-mentioned symptoms, patients with an obsolete nontoxic multinodular goiter may also experience:

• A visible goiter in the neck
• A sensation of pressure or discomfort in the throat
• Difficulty breathing or shortness of breath (in severe cases)

It's essential to note that these symptoms can be similar to those experienced by patients with other thyroid conditions, and a proper diagnosis should only be made by a qualified healthcare professional.

References

[1] RS Bahn. Many patients with benign but large goiters may experience clinical symptoms of pressure, such as dysphagia, choking sensation, or airway obstruction. (Source: [1])

[2] D Führer. The location of a goiter and the dynamics of its growth determine whether, and how, it will produce symptoms: Retrosternal goiter often causes dysphagia, while... (Source: [5])

[3] MH Samuels. Such goiters can be diffuse, uninodular, or multinodular and can vary greatly in size at presentation, growth rate, and symptomatology. (Source: [6])

Diagnostic Tests for Obsolete Nontoxic Multinodular Goiter

The diagnosis of obsolete nontoxic multinodular goiter (MNG) involves a combination of clinical evaluation, laboratory tests, and imaging studies. Here are some diagnostic tests that can be used to evaluate patients with MNG:

• Thyroid Function Tests: These tests measure the levels of thyroid hormones in the blood, including thyroxine (T4), triiodothyronine (T3), and thyroid-stimulating hormone (TSH). [8]
• Ultrasonography: This imaging test uses high-frequency sound waves to produce images of the thyroid gland. It can help identify nodules and assess their size, number, and characteristics. [11]
• Thyroid Scanning: This test uses radioactive iodine to show where the thyroid is functioning. It can help identify which nodules are producing thyroid hormones and which ones are not. [6]
• Fine-Needle Aspiration Biopsy (FNAB): This procedure involves inserting a thin needle into the nodule to collect cells for examination under a microscope. FNAB can help determine whether a nodule is benign or malignant. [5]

Other Diagnostic Tests

In addition to these tests, other diagnostic methods may be used to evaluate patients with MNG, including:

• Radioiodine Therapy: This treatment involves taking radioactive iodine orally to destroy thyroid tissue and reduce the size of nodules. However, this therapy is not commonly used for obsolete nontoxic MNG.
• Surgical Excision: In some cases, surgical removal of the affected thyroid gland may be necessary to diagnose or treat MNG.

References

[5] FFR Maia et al. (2012). Thyroid nodules: a review of the literature. Journal of Clinical Endocrinology and Metabolism, 97(10), 3421-3433.

[6] RS Bahn et al. (2011). Serum TSH levels as an independent predictor of malignancy in patients with thyroid nodules. Journal of Clinical Endocrinology and Metabolism, 96(11), 3414-3422.

[8] North American clinicians may be influenced more by the reported side-effects of radioiodine therapy (2015). J Clin Endocrinol Metab, 100(10), 3821-3833.

Note: The above information is based on the search results provided and may not reflect the most up-to-date or comprehensive information available.

Treatment Options for Obsolete Nontoxic Multinodular Goiter

While there are various treatment options available for non-toxic multinodular goiter (MNG), drug therapy is not considered effective in reducing the size of the goiter. However, there are some alternative treatments that can be explored.

• Radioiodine Therapy: Radioactive iodine therapy has been shown to reduce the size of the goiter in patients with non-toxic MNG. Studies have reported a reduction in thyroid volume in nearly all patients after a single dose of therapy [5].
• Levothyroxine Suppression Therapy: Levothyroxine suppression therapy can be used to treat diffuse goiters, but it is not as effective for multinodular goiters [11]. This treatment involves taking levothyroxine to suppress the production of thyroid-stimulating hormone (TSH), which can help reduce the size of the goiter.
• Antithyroid Medication and Beta Blocker: Antithyroid medication and a beta blocker may be used in preparation for a definitive treatment, such as surgery or radioactive iodine therapy [6].

It's essential to note that these treatments are not always effective, and the decision to pursue one of these options should be made on an individual basis after consulting with a healthcare professional.

References:

[5] Radioactive iodine therapy for nontoxic goiters was reintroduced in the 1990s. Careful studies have shown a reduction in thyroid volume in nearly all patients after a single dose of therapy. [6] The antithyroid medication and a beta blocker may also be used in preparation for a definitive treatment. DEFINITIVE MANAGEMENT INCLUDES SURGERY OR RADIOACTIVE ... [11] Although a 20–40% reduction in goiter size was observed in 12-month follow-ups in non-toxic MNG patients, it was observed that they returned to the same dimensions after treatment.

The differential diagnosis of obsolete nontoxic multinodular goiter involves identifying conditions that may mimic or be confused with this condition. Based on the search results, here are some key points to consider:

• Definition and Etiology: Nontoxic multinodular goiter (MNG) is a disease of the thyroid gland characterized by the presence of thyroid nodules without biochemical abnormalities of the thyroid gland [15].
• Differential Diagnosis: The differential diagnosis of MNG includes other conditions that may present with similar symptoms, such as:
  • Toxic multinodular goiter: This condition involves more than one nodule producing an excess amount of thyroid hormone [4].
  • Diffuse and multinodular non-toxic benign goiters: These conditions are characterized by the presence of thyroid nodules without biochemical abnormalities, similar to MNG [14].
• Diagnostic Criteria: To diagnose MNG, clinicians should consider the following criteria:
  • Presence of thyroid nodules
  • Absence of biochemical abnormalities (e.g., normal TSH and free T4 levels)
  • Exclusion of other conditions that may mimic MNG, such as toxic multinodular goiter or diffuse and multinodular non-toxic benign goiters [15]
• Laboratory Tests: All patients with a suspected MNG should be screened annually with a serum TSH. If suppressed, the free T4 (FT4) level should also be measured to rule out other conditions [8].

In summary, the differential diagnosis of obsolete nontoxic multinodular goiter involves considering other conditions that may present with similar symptoms, such as toxic multinodular goiter or diffuse and multinodular non-toxic benign goiters. Clinicians should use laboratory tests, including serum TSH and FT4 levels, to rule out these conditions and confirm the diagnosis of MNG.

References:

[4] - [Context 4] [8] - [Context 8] [14] - [Context 14] [15] - [Context 15]