ENDOCRINE ROUNDS CASE 2- A CASE OF TOXIC ADENOMA

A 42 year old female had history of weight loss. On examination she was found to have a thyroid nodule with thyroid function test showing reduced TSH and increased T4.


We asked for a Tc99 Pertechnetate thyroid scan which is shown above.
Q. What is the interpretation of the thyroid scan report ?

It shows an autonomous hot nodule on the left lobe of thyroid. No cold nodules.

Q. What are the treatment options for this patient ?

Start the patient on Beta blockers at the time of diagnosis for symptom control.
The preferred therapy would be either surgery or radioiodine therapy. Radioiodine would be preferred over surgery as per AACE/ATA guidelines in this case considering the size of the nodule.

Q If surgery is preferred option for option, then what should be the extent of surgery in this case ?

Ipsilateral lobectomy can be done. (After ruling out absence of thyroid nodules in other lobe)

Q Will radioiodine therapy also reduce the size of the Toxic adenoma ?
Yes

Q Risk of hypothyroidism is more in Toxic adenoma compared to Graves or less ?

It is less compared to Graves as the radioactive iodine only accumluates in the toxic adenoma

Q If the patient is pretreated with carbimazole, what should be the TSH when radioiodine therapy is administered ?

It should ideally be administered when the TSH is lower (or has not normalized). In this case the damage to the normal thyroid tissue is avoided and hence post procedure hypothyroidism is avoided.

Q What is the success rate of radioiodine therapy in toxic adenoma ?

80-90%

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