A toxic thyroid adenoma is 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 or surgery, 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
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