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Toxic multinodular goiter

Последний просмотренный: 16 Aug 2025
Last updated: 26 Oct 2022

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

  • goiter
Полная информация

Другие диагностические факторы

  • heat intolerance, hyperphagia, or weight loss
  • depression
  • nervousness or palpitations
  • oligomenorrhea
  • hyperdefecation
  • stare or lid lag
  • warm, moist skin
  • tachycardia
  • irregular pulse
  • tremor
  • muscle weakness
  • shortness of breath or choking sensation
  • Pemberton sign
Полная информация

Факторы риска

  • iodine deficiency
  • age >40 years
  • head and neck irradiation
  • family history of thyroid nodules
  • female sex
Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

  • thyroid-stimulating hormone (TSH)
Полная информация

Исследования, проведение которых нужно рассмотреть

  • free T4 (or total T4 with a measure of binding)
  • total T3 with a measure of binding (or free T3)
  • I-123 thyroid scan and uptake
  • Tc-99 pertechnetate scan
  • thyroid ultrasound
  • metabolic panel
  • CBC
  • thyroid peroxidase antibodies
  • TSH receptor antibodies
  • ECG
  • CT neck (noncontrast)
Полная информация

Алгоритм лечения

ПРОДОЛЖЕНИЕ

nonpregnant nonlactating adults: without mass effect or suspicion of cancer

mass effect or suspicion of cancer

pregnant or lactating: without mass effect or suspicion of cancer

Составители

Авторы

Elizabeth N. Pearce, MD

Professor of Medicine

Boston University Medical Center

Boston

MA

Раскрытие информации

ENP is a member of the Management Council of the Iodine Global Network. She was the 2018-2019 President of the American Thyroid Association (ATA) and served on its board and executive committee until 2020. She is a current member of the ATA's thyroid in pregnancy guidelines writing task force. She is currently a Deputy Editor at the Journal of Clinical Endocrinology and Metabolism and has previously served as an Associated Editor for the journals Thyroid, Endocrine Practice, and Clinical Thyroidology. She is an author of a number of references cited in this topic.

Выражение благодарностей

Dr Elizabeth N. Pearce would like to gratefully acknowledge Dr Sheila Feit, a previous contributor to this topic. SF was previously employed by BMJ.

Рецензенты

Petros Perros, BSc, MBBS, MD, FRCP

Consultant Endocrinologist

Freeman Hospital

Newcastle-Upon-Tyne

UK

Раскрытие информации

PP declares that he has no competing interests.

Ronald Merrell, MD, FACS

Professor of Surgery

Virginia Commonwealth University

Richmond

VA

Раскрытие информации

RM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

Gharib H, Papini E, Garber JR, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules - 2016 update. Endocr Pract. 2016 May;22(5):622-39.Полный текст  Аннотация

Zimmermann MB, Boelaert K. Iodine deficiency and thyroid disorders. Lancet Diabetes Endocrinol. 2015 Apr;3(4):286-95. Аннотация

Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26:1343-1421.Полный текст  Аннотация

Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26:1-133.Полный текст  Аннотация

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Toxic multinodular goiter images
  • Differentials

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    • Toxic adenoma
    • Thyrotoxic phase of painless/lymphocytic thyroiditis
    Больше Отличия
  • Guidelines

    • Thyroid nodule algorithmic tool white paper
    • Definitive surgical management of thyroid disease in adults
    Больше Guidelines
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