Management of the hot thyroid nodule

• Published in: The American journal of surgery 1995-11, Vol.170 (5), p.481-483
• Main Authors: David, Elizabeth, Rosen, Irving B., Bain, Jerald, James, Jacqueline, Kirsh, Joel C.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma, Follicular - pathology; Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma - pathology; Complications; Disease Progression; Endocrinopathies; Female; Follow-Up Studies; Graves Disease - pathology; Humans; Hyperparathyroidism; Hyperparathyroidism - etiology; Hyperthyroidism; Hyperthyroidism - pathology; Iatrogenesis; Iodine; Iodine radioisotopes; Iodine Radioisotopes - adverse effects; Iodine Radioisotopes - therapeutic use; Male; Malignancy; Medical sciences; Middle Aged; Morbidity; Nodules; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Patients; Radioisotopes; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid; Thyroid gland; Thyroid Neoplasms - pathology; Thyroid Nodule - diagnostic imaging; Thyroid Nodule - therapy; Thyroid. Thyroid axis (diseases); Thyroidectomy; Thyroidectomy - methods; Thyroxine - therapeutic use; Toxicity; Triiodothyronine - therapeutic use
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(99)80334-1

Background: Solitary hyperfunctioning nodules of the thyroid gland are usually viewed as benign. They may present with autonomous euthyroidism but are of concern for potential progression to hyperthyroidism. Various methods of treatment are worthy of consideration. Patients and methods: Forty-five patients with solitary hot thyroid nodules verified by radioisotope scintiscanning were selected for treatment. Thirty-one underwent surgery, usually partial thyroidectomy. Eight euthyroid patients received no treatment, 5 underwent therapy with radioactive iodine (RAI), and 1 received thyroid suppression treatment. The cases were assessed retrospectively. Results: Thyroidectomy patients had no morbidity, were well, and showed 1 Hürthle cell tumor and 5 coincidental small malignancies associated with benign hot nodules, including a contralateral cancer. Untreated patients showed continuance of good health, but nodules persisted and 1 Graves' orbititis occurred. The RAI-treated patients had persistent nodularity, improved function, and 1 case of hyperparathyroidism. Thyroid feeding only caused iatrogenic toxicity and was discontinued. Conclusions: There are various techniques for managing the hot nodule. Nonsurgical methods may be effective, but can result in persistent nodularity and iatrogenic sequelae. Excision had no morbidity in this series and was effective in providing immediate relief of problems present and potential.