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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 and iron deficiency,selenium deficiency.


==Risk Factors==


*Common risk factors in the development of multinodular goiter include:
==Laboratory Findings==
**Female sex
*Diagnosis of multinodular goiter is made by measurement of  serum thyroid-stimulating hormone (TSH)  , serum Free T4 test , total thyroxine (T4) and  free triiodothyronine (T3).<ref name="pmid26462967">{{cite journal |vauthors=Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L |title=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 |journal=Thyroid |volume=26 |issue=1 |pages=1–133 |year=2016 |pmid=26462967 |pmc=4739132 |doi=10.1089/thy.2015.0020 |url=}}</ref>
**Age over 50 years
*Additional tests include:
**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>
**serum thyroglobulin and thyroid autoantibodies to detect autoimmunity that may co-exist with goiter and lung function testing
**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>
**Urinary iodine excretion can be measured in case of suspected iodine excess.
*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>
*Laboratory findings consistent with the diagnosis of multinodular goiter include:<ref name="pmid12588812">{{cite journal |vauthors=Hegedüs L, Bonnema SJ, Bennedbaek FN |title=Management of simple nodular goiter: current status and future perspectives |journal=Endocr. Rev. |volume=24 |issue=1 |pages=102–32 |year=2003 |pmid=12588812 |doi=10.1210/er.2002-0016 |url=}}</ref>
**Millet, soy beans, coconut, babassu contain flavonoids that impair thyroperoxidase.
**TSH is usually normal or decreased.
**Cassava, sweet potato, sorghum contain cyanogenic glucosides metabolized to thiocyanates that Inhibits iodine thyroidal uptake.
**free T4, and free T3 is usually Normal or elevated.
**Cabbage, cauliflower, Broccoli, turnips contain glucosinolates that impair iodine thyroidal uptake.
**An isolated increase in T4 is observed in:
**Seaweed (kelp) contains excess iodine that inhibits release of thyroidal hormones.
***hyperthyroidism induced by iodine
*Vitamin A and Iron deficiency increases TSH stimulation and reduces heme-dependent thyroperoxidase thyroidal activity.
***Hyperthyroidism due to agents that reduce peripheral conversion of T4 to triiodothyronine (T3) like:<ref name="pmid26462967">{{cite journal |vauthors=Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L |title=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 |journal=Thyroid |volume=26 |issue=1 |pages=1–133 |year=2016 |pmid=26462967 |pmc=4739132 |doi=10.1089/thy.2015.0020 |url=}}</ref>
*Selenium deficiency accumulates peroxidase and causes deiodinase deficiency resulting in impaired thyroid hormone synthesis.
****Propranolol
*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>
****Corticosteroids
****Radiocontrast agents
****Amiodarone
**Serum thyroglobulin is usually elevated.
**Thyroid autoantibodies (TPO and Tg) usually negative.
**Some patients with multinodular goiter may have impaired inspiratory capacity lung function testing.
 
 
 


==References==
==References==
{{Reflist|2}}


{{Reflist|2}}
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Revision as of 20:48, 9 October 2017


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mazia Fatima, MBBS [2]

Overview

Laboratory Findings

  • Diagnosis of multinodular goiter is made by measurement of serum thyroid-stimulating hormone (TSH) , serum Free T4 test , total thyroxine (T4) and free triiodothyronine (T3).[1]
  • Additional tests include:
    • serum thyroglobulin and thyroid autoantibodies to detect autoimmunity that may co-exist with goiter and lung function testing
    • Urinary iodine excretion can be measured in case of suspected iodine excess.
  • Laboratory findings consistent with the diagnosis of multinodular goiter include:[2]
    • TSH is usually normal or decreased.
    • free T4, and free T3 is usually Normal or elevated.
    • An isolated increase in T4 is observed in:
      • hyperthyroidism induced by iodine
      • Hyperthyroidism due to agents that reduce peripheral conversion of T4 to triiodothyronine (T3) like:[1]
        • Propranolol
        • Corticosteroids
        • Radiocontrast agents
        • Amiodarone
    • Serum thyroglobulin is usually elevated.
    • Thyroid autoantibodies (TPO and Tg) usually negative.
    • Some patients with multinodular goiter may have impaired inspiratory capacity lung function testing.



References

  1. ↑ 1.0 1.1 Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L (2016). "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. 26 (1): 1–133. doi:10.1089/thy.2015.0020. PMC 4739132. PMID 26462967.
  2. ↑ Hegedüs L, Bonnema SJ, Bennedbaek FN (2003). "Management of simple nodular goiter: current status and future perspectives". Endocr. Rev. 24 (1): 102–32. doi:10.1210/er.2002-0016. PMID 12588812.

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