Condition Overview
Toxic (Autonomous) Thyroid Nodule, also known as a hyperfunctioning or hot nodule or an Autonomously Functioning Thyroid Nodule (AFTN), is a type of thyroid nodule that produces thyroid hormones independently of the regulatory mechanisms of the thyroid gland. This leads to hyperthyroidism, a condition characterized by elevated levels of thyroid hormones in the blood. Unlike other thyroid nodules, toxic nodules actively secrete thyroid hormones, causing symptoms of hyperthyroidism.
Patients with a toxic thyroid nodule may experience symptoms such as weight loss, increased appetite, nervousness, irritability, heat intolerance, increased sweating, palpitations, and tremors. They may also have an enlarged thyroid gland (goiter) and exhibit signs of thyrotoxicosis, such as a rapid heartbeat and high blood pressure.
Diagnosis involves blood tests to measure levels of thyroid hormones (T3 and T4) and thyroid-stimulating hormone (TSH), which are typically low due to feedback inhibition. A thyroid scan using radioactive iodine or technetium can identify the hyperfunctioning nodule, as it will take up more of the radioactive substance than the surrounding thyroid tissue (hot nodule). Ultrasound imaging may also be used to assess the nodule's characteristics.
Treatment Options
- Radiofrequency Ablation (RFA)
- Description: RFA is a minimally invasive procedure that uses heat generated by radiofrequency energy to destroy the hyperfunctioning thyroid tissue. This can reduce the size of the nodule and alleviate symptoms of hyperthyroidism without the need for surgery. While popular, this is not usually the first line recommendation because nodules come back and more treatment is required about 50% of the time.
- Indications: Symptomatic toxic nodules, patients seeking non-surgical treatment options, nodules causing compressive symptoms. Usually, patients with large toxic nodules are not great candidates for RFA, as the nodule is likely to return.
- Thyroid Lobectomy
- Description: This surgical procedure involves the removal of the lobe of the thyroid gland containing the toxic nodule. It is a definitive treatment option that can provide symptom relief and prevent recurrence. At the Russell Center, this can be done with or without a scar.
- Indications: Large or symptomatic nodules, patient preference for surgical treatment, nodules with suspicious features that may warrant histopathological examination.
- Radioactive Iodine (RAI) Therapy
- Description: RAI therapy involves the oral administration of a small amount of radioactive iodine, which is selectively taken up by the hyperfunctioning thyroid tissue. The radiation destroys the nodule's cells, reducing its activity and size.
- Indications: Patients with toxic nodules who prefer non-surgical treatment, those unfit for surgery, recurrent or persistent hyperthyroidism after other treatments.
- Anti-Thyroid Drugs
- Description: Medications such as methimazole and propylthiouracil can be used to decrease the amount of thyroid hormone that circulates in the body. This is generally utilized in the short term until a more definitive form of treatment is selected.
- Indications: poor candidate for other treatment, wants to avoid surgery or radiation, short term bridge to another treatment
Management of toxic thyroid nodules requires a multidisciplinary approach involving endocrinologists, radiologists, and surgeons. The choice of treatment depends on the patient's symptoms, nodule size, and preferences. Regular monitoring and follow-up are essential to ensure successful outcomes and manage any potential recurrence of hyperthyroidism. Having an experienced team such as that at the Russell Center ensures that you will have access to the widest range of options for your toxic thyroid nodule.
