Toxic multinodular goiter risk factors: Difference between revisions
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==Overview== | ==Overview== | ||
Common risk factors in the development of multinodular goiter include female sex,age over 50 years,areas with decreased iodine intake,iodine supplementation, natural goitrogens,vitamin A | Common risk factors in the development of multinodular goiter include female sex, age over 50 years, areas with decreased [[iodine]] intake, iodine supplementation, natural goitrogens, [[vitamin A deficiency]], [[iron deficiency]] and [[selenium deficiency]]. | ||
==Risk Factors== | ==Risk Factors== | ||
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**Age over 50 years | **Age over 50 years | ||
**[[Smoking]]<ref name="pmid11838733">{{cite journal |vauthors=Vestergaard P, Rejnmark L, Weeke J, Hoeck HC, Nielsen HK, Rungby J, Laurberg P, Mosekilde L |title=Smoking as a risk factor for Graves' disease, toxic nodular goiter, and autoimmune hypothyroidism |journal=Thyroid |volume=12 |issue=1 |pages=69–75 |year=2002 |pmid=11838733 |doi=10.1089/105072502753451995 |url=}}</ref> | **[[Smoking]]<ref name="pmid11838733">{{cite journal |vauthors=Vestergaard P, Rejnmark L, Weeke J, Hoeck HC, Nielsen HK, Rungby J, Laurberg P, Mosekilde L |title=Smoking as a risk factor for Graves' disease, toxic nodular goiter, and autoimmune hypothyroidism |journal=Thyroid |volume=12 |issue=1 |pages=69–75 |year=2002 |pmid=11838733 |doi=10.1089/105072502753451995 |url=}}</ref> | ||
**Areas with decreased iodine intake<ref name="pmid2040867">{{cite journal |vauthors=Laurberg P, Pedersen KM, Vestergaard H, Sigurdsson G |title=High incidence of multinodular toxic goitre in the elderly population in a low iodine intake area vs. high incidence of Graves' disease in the young in a high iodine intake area: comparative surveys of thyrotoxicosis epidemiology in East-Jutland Denmark and Iceland |journal=J. Intern. Med. |volume=229 |issue=5 |pages=415–20 |year=1991 |pmid=2040867 |doi= |url=}}</ref> | **Areas with decreased [[iodine]] intake<ref name="pmid2040867">{{cite journal |vauthors=Laurberg P, Pedersen KM, Vestergaard H, Sigurdsson G |title=High incidence of multinodular toxic goitre in the elderly population in a low iodine intake area vs. high incidence of Graves' disease in the young in a high iodine intake area: comparative surveys of thyrotoxicosis epidemiology in East-Jutland Denmark and Iceland |journal=J. Intern. Med. |volume=229 |issue=5 |pages=415–20 |year=1991 |pmid=2040867 |doi= |url=}}</ref> | ||
*Natural goitrogens associated with the development of multinodular goiter include:<ref name="pmid2464986">{{cite journal |vauthors=Gaitan E |title=Goitrogens |journal=Baillieres Clin. Endocrinol. Metab. |volume=2 |issue=3 |pages=683–702 |year=1988 |pmid=2464986 |doi= |url=}}</ref> | *Natural [[goitrogen|goitrogens]] associated with the development of multinodular goiter include:<ref name="pmid2464986">{{cite journal |vauthors=Gaitan E |title=Goitrogens |journal=Baillieres Clin. Endocrinol. Metab. |volume=2 |issue=3 |pages=683–702 |year=1988 |pmid=2464986 |doi= |url=}}</ref> | ||
**Millet, soy beans, coconut, babassu contain flavonoids that impair thyroperoxidase. | **Millet, soy beans, coconut, babassu contain [[flavonoids]] that impair [[thyroperoxidase]] enzyme. | ||
**Cassava, sweet potato, sorghum contain cyanogenic glucosides metabolized to thiocyanates that | **Cassava, sweet potato, sorghum contain cyanogenic [[glucosides]] metabolized to [[thiocyanates]] that inhibits thyroid iodine uptake. | ||
**Cabbage, cauliflower, | **Cabbage, cauliflower, broccoli, turnips contain glucosinolates that impair thyroid iodine uptake. | ||
**Seaweed (kelp) contains excess iodine that inhibits release of | **Seaweed (kelp) contains excess iodine that inhibits release of thyroid hormones. | ||
*[[Vitamin A]] and [[ | *[[Vitamin A]] and [[iron deficiency]] increases [[TSH]] stimulation and reduces heme-dependent [[thyroperoxidase]] activity. | ||
*Selenium deficiency accumulates peroxidase and causes deiodinase deficiency resulting in impaired thyroid hormone synthesis. | *Selenium deficiency accumulates peroxidase and causes deiodinase deficiency resulting in impaired [[thyroid hormone]] synthesis. | ||
*Iodine supplementation or iodinated contrast agents or iodinated drugs, such as [[amiodarone]], may also induce [[hyperthyroidism]] in patients with underlying nontoxic multinodular goiter(Jod-Basedow effect).<ref name="pmid23148056">{{cite journal |vauthors=Dunne P, Kaimal N, MacDonald J, Syed AA |title=Iodinated contrast-induced thyrotoxicosis |journal=CMAJ |volume=185 |issue=2 |pages=144–7 |year=2013 |pmid=23148056 |pmc=3563887 |doi=10.1503/cmaj.120734 |url=}}</ref> | *Head or neck [[irradiation]] in an adult is associated with increased frequency of toxic nodular goiter. | ||
*[[Iodine]] supplementation or [[iodinated contrast]] agents or iodinated drugs, such as [[amiodarone]], may also induce [[hyperthyroidism]] in patients with underlying nontoxic multinodular goiter (Jod-Basedow effect).<ref name="pmid23148056">{{cite journal |vauthors=Dunne P, Kaimal N, MacDonald J, Syed AA |title=Iodinated contrast-induced thyrotoxicosis |journal=CMAJ |volume=185 |issue=2 |pages=144–7 |year=2013 |pmid=23148056 |pmc=3563887 |doi=10.1503/cmaj.120734 |url=}}</ref> | |||
==References== | ==References== | ||
Latest revision as of 11:55, 13 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mazia Fatima, MBBS [2]
Overview
Common risk factors in the development of multinodular goiter include female sex, age over 50 years, areas with decreased iodine intake, iodine supplementation, natural goitrogens, vitamin A deficiency, iron deficiency and selenium deficiency.
Risk Factors
- Common risk factors in the development of multinodular goiter include:
- Natural goitrogens associated with the development of multinodular goiter include:[3]
- Millet, soy beans, coconut, babassu contain flavonoids that impair thyroperoxidase enzyme.
- Cassava, sweet potato, sorghum contain cyanogenic glucosides metabolized to thiocyanates that inhibits thyroid iodine uptake.
- Cabbage, cauliflower, broccoli, turnips contain glucosinolates that impair thyroid iodine uptake.
- Seaweed (kelp) contains excess iodine that inhibits release of thyroid hormones.
- Vitamin A and iron deficiency increases TSH stimulation and reduces heme-dependent thyroperoxidase activity.
- Selenium deficiency accumulates peroxidase and causes deiodinase deficiency resulting in impaired thyroid hormone synthesis.
- Head or neck irradiation in an adult is associated with increased frequency of toxic nodular goiter.
- Iodine supplementation or iodinated contrast agents or iodinated drugs, such as amiodarone, may also induce hyperthyroidism in patients with underlying nontoxic multinodular goiter (Jod-Basedow effect).[4]
References
- ↑ Vestergaard P, Rejnmark L, Weeke J, Hoeck HC, Nielsen HK, Rungby J, Laurberg P, Mosekilde L (2002). "Smoking as a risk factor for Graves' disease, toxic nodular goiter, and autoimmune hypothyroidism". Thyroid. 12 (1): 69–75. doi:10.1089/105072502753451995. PMID 11838733.
- ↑ Laurberg P, Pedersen KM, Vestergaard H, Sigurdsson G (1991). "High incidence of multinodular toxic goitre in the elderly population in a low iodine intake area vs. high incidence of Graves' disease in the young in a high iodine intake area: comparative surveys of thyrotoxicosis epidemiology in East-Jutland Denmark and Iceland". J. Intern. Med. 229 (5): 415–20. PMID 2040867.
- ↑ Gaitan E (1988). "Goitrogens". Baillieres Clin. Endocrinol. Metab. 2 (3): 683–702. PMID 2464986.
- ↑ Dunne P, Kaimal N, MacDonald J, Syed AA (2013). "Iodinated contrast-induced thyrotoxicosis". CMAJ. 185 (2): 144–7. doi:10.1503/cmaj.120734. PMC 3563887. PMID 23148056.