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Toxic multinodular goiter

Última revisão: 24 Sep 2025
Última atualização: 26 Oct 2022

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • goiter
Detalhes completos

Outros fatores diagnósticos

  • 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
Detalhes completos

Fatores de risco

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

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • thyroid-stimulating hormone (TSH)
Detalhes completos

Investigações a serem consideradas

  • 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)
Detalhes completos

Algoritmo de tratamento

CONTÍNUA

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

Colaboradores

Autores

Elizabeth N. Pearce, MD

Professor of Medicine

Boston University Medical Center

Boston

MA

Declarações

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.

Agradecimentos

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

Revisores

Petros Perros, BSc, MBBS, MD, FRCP

Consultant Endocrinologist

Freeman Hospital

Newcastle-Upon-Tyne

UK

Declarações

PP declares that he has no competing interests.

Ronald Merrell, MD, FACS

Professor of Surgery

Virginia Commonwealth University

Richmond

VA

Declarações

RM declares that he has no competing interests.

Créditos aos pareceristas

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Declarações

As afiliações e declarações dos pareceristas referem--se ao momento da revisão.

Referências

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Principais artigos

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.Texto completo  Resumo

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

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.Texto completo  Resumo

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.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Toxic multinodular goiter images
  • Diagnósticos diferenciais

    • Graves disease
    • Toxic adenoma
    • Thyrotoxic phase of painless/lymphocytic thyroiditis
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  • Diretrizes

    • Thyroid nodule algorithmic tool white paper
    • Definitive surgical management of thyroid disease in adults
    Mais Diretrizes
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