Bocio multinodular tóxico
Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- bocio
Other diagnostic factors
- intolerancia al calor, hiperfagia o pérdida de peso
- depresión
- nerviosismo o palpitaciones
- oligomenorrea
- aumento del ritmo intestinal
- mirada fija o retracción palpebral
- piel caliente y húmeda
- taquicardia
- pulso irregular
- temblor
- debilidad muscular
- dificultad para respirar o sensación de ahogo
- signo de Pemberton
Risk factors
- deficiencia de yodo
- edad >40 años
- irradiación del cuello y la cabeza
- antecedentes familiares de nódulos tiroideos
- sexo femenino
Diagnostic tests
1st tests to order
- hormona estimulante de la tiroides (TSH)
Tests to consider
- tiroxina (T4) libre (o T4 total con análisis de fijación)
- triyodotironina (T3) total con análisis de fijación (o T3 libre)
- gammagrafía tiroidea y prueba de captación tiroidea con I-123
- gammagrafía con Tc-99 pertecnetato
- ultrasonido de tiroides
- perfil metabólico
- hemograma completo (HC)
- anticuerpos anti-tiroperoxidasa
- anticuerpos contra receptores de TSH
- electrocardiograma (ECG)
- TC de cuello (sin contraste)
Treatment algorithm
adultos excepto mujeres embarazadas o en periodo de lactancia: sin efecto de masa ni sospecha de cáncer
efecto de masa o sospecha de cáncer
mujeres embarazadas o en periodo de lactancia: sin efecto de masa ni sospecha de cáncer
Contributors
Authors
Elizabeth N. Pearce, MD
Professor of Medicine
Boston University Medical Center
Boston
MA
Disclosures
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.
Acknowledgements
Dr Elizabeth N. Pearce would like to gratefully acknowledge Dr Sheila Feit, a previous contributor to this topic. SF was previously employed by BMJ.
Peer reviewers
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.
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Referências
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 Jan;26(1):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.
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