Toxic multinodular goiter risk factors
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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.