Diagnosis and management of the autonomously functioning thyroid nodule: the Walter Reed Army Medical Center experience, 1975-1996.

摘要: In order to characterize the clinical and laboratory features of autonomously functioning thyroid nodules (AFTNs), assess optimal diagnosis management patients with this disorder, we performed a retrospective analysis 49 such over 22-year period encompassing January 1975 November 1996. The following data were analyzed: hormone levels, scintiscan, radioiodine uptake, fine-needle aspiration biopsy, triiodothyronine (T3) suppression testing, thyrotropin-releasing (TRH) stimulation test, ultrasound. Clinical outcomes assessed included persistent hyperthyroidism, hypothyroidism, nodule shrinkage after treatment, or in followed without definitive therapy, growth, spontaneous degeneration, progression hyperthyroidism. Biochemical often subclinical, was found 73.5% at presentation an additional 24.4% during subsequent follow-up. introduction sensitive thyrotropin (TSH) testing study resulted decrease use T3-suppression test TRH from 100% 20%, respectively, 1976-1980, 4% each 1991-1996. T3-thyrotoxicosis occurred 12.2% patients. Thyrotoxicosis any time course follow-up positively correlated size diagnosis. Definitive used 42.8% patients, consisted ablation (38.1%) thyroidectomy (61.9%). No patient had recurrence thyrotoxicosis but 25% became hypothyroid. During for mean 30.9 months, enlarged overall, 33% not receiving therapy. Cystic degeneration documented 26.5% although change rarely reversed subclinical AFTN requires demonstration TSH-independent nodular hyperfunction. TSH assays has simplified evaluation revealed high prevalence hyperfunction disorder. view current increased awareness adverse consequences associated hyperthyroidism rarity resolution (despite propensity hemorrhage), therapy is recommended. Both hemithyroidectomy have cure rates low posttreatment incidence hypothyroidism.