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, iron deficiency and selenium deficiency. | 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. | ||
*Head or neck irradiation in an adult is associated with increased frequency of toxic nodular goiter. | *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> | *[[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.