Typically a single large thyroid nodule accompanied by clinical and biochemical hyperthyroidism.
Diagnosis confirmed by thyroid scan demonstrating a hot area and suppression of extranodular thyroid tissue.
Hyperthyroidism caused by toxic adenomas generally does not remit.
Definitive treatment, such as radioactive iodine therapy, is usually required.
Complications of untreated toxic adenomas may include sequelae of hyperthyroidism such as cardiac dysfunction or bone loss, or tracheal compression by large nodules.
A toxic adenoma is an autonomously functioning thyroid nodule that causes hyperthyroidism. These nodules are almost always benign. Some autonomous nodules cause only subclinical hyperthyroidism, with suppressed thyroid-stimulating hormone (TSH) level and normal concentrations of free thyroid hormones.
History and exam
Key diagnostic factors
- presence of risk factors
- palpable thyroid nodule
- younger age
Other diagnostic factors
- weight loss
- sweating/heat intolerance
- stare or lid lag
- warm moist skin
- muscle weakness
- mood change
- young adult age
- iodine deficiency
- head and neck irradiation
- family history of thyroid nodules
- female sex
1st investigations to order
- thyroid stimulating hormone (TSH)
- thyroid ultrasound
Investigations to consider
- free thyroxine (T4; or total T4 with a measure of binding)
- total T3 with a measure of binding (or free T3)
- thyroid scan and uptake
- metabolic panel
- TSH receptor antibodies
- thyroid peroxidase antibodies
- CT neck (non-contrast)
non-pregnant non-lactating adults without mass effect
non-pregnant non-lactating adults with mass effect
pregnant or lactating
Elizabeth N. Pearce, MD
Associate Professor of Medicine
Boston University Medical Center
ENP has received honoraria and travel funding for speaking at two international conferences for Merck Serono and at one for IBSA. She is a member of the Management Council of the Iodine Global Network. She is an author of a number of references cited in this topic.
Dr Elizabeth N. Pearce would like to gratefully acknowledge Dr Sheila Feit, the previous contributor to this topic.
John C. Morris, MD
Professor of Medicine
JCM declares that he has no competing interests.
Petros Perros, BSc, MBBS, MD, FRCP
PP declares that he has no competing interests.
- Graves' disease
- Toxic multinodular goitre
- Thyrotoxic phase of painless lymphocytic thyroiditis
- 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum
- Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules
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