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Evaluation of Euthyroid Solitary Autonomous Nodule of the Thyroid Gland: Title and subTitle BreakImportance of Scintillation Scanning and Thyrotropin-Releasing Hormone Testing FREE

Manfred Blum, MD; Terry F. Seltzer, MD; Chris C. Campbell, MD; Valentine J. Burroughs, MD
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JAMA. 1982;247(14):1991-1993. doi:10.1001/jama.1982.03320390053043
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The euthyroid autonomous nodule of the thyroid may escape diagnosis if only the usual criterion of less than 50% suppression of radioactive iodine uptake (RAIU) after administration of liothyronine sodium is employed. This was the case in four patients who had thyrotoxic response to suppressive therapy, which had been given as a result of the improper conclusion that a nodule was hyperplastic, after the RAIU had fallen. We studied 95 patients with a solitary functioning nodule and found ten euthyroid persons (11 tests) in whom scintiscans showed persistent function in the nodule in spite of suppression of the RAIU by more than 50%. A thyrotropin-releasing hormone test demonstrated lack of thyroid-stimulating hormone responsiveness after administration of liothyronine, proving adequacy of the suppressive dose. Diagnosis of an autonomous nodule should not be excluded unless a scintiscan reveals that its function, in distinction to the rest of the gland, is curtailed by adequate suppression.

(JAMA 1982;247:1991-1993)

REFERENCES

Hollander CS, Mitsuma T, Nihei N, et al:  T-3 toxicosis: Clinical and laboratory observations on 40 patients with documentation by radioimmunoassay . Lancet 1972;;1:609-611.
Hershman JM, Pittman JA Jr:  Response to synthetic thyrotropin-releasing hormone in man . J Clin Endocrinol Metab 1970;;31:457-460.
Hershman JM:  Clinical application of thyrotropin-releasing hormone . N Engl J Med 1974;; 290:886-890.
Werner SC, Spooner M:  A new and simple test for hyperthyroidism employing L-triiodothyronine and the 24-hour I-131 uptake method . Bull NY Acad Med 1955;;31:137-145.
Silver S: Radioactive Isotopes in Medicine and Biology (Medicine) , ed 2. Philadelphia, Lea & Febiger Inc, 1962;, p 52.
Blum M, Shenkman L, Hollander CS:  The autonomous nodule of the thyroid: Correlation of patient age, nodule size and functional status . Am J Med Sci 1975;;269:43-50.
Ridgeway ES, Weintraub BD, Cevallos JL, et al:  Suppression of pituitary TSH secretion in the patient with a hyperfunctioning thyroid nodule . J Clin Invest 1973;;52:2783-2792.
Burke G:  The triiodothyronine suppression test . Am J Med 1967;;42:600-608.
Hamburger JI:  Solitary autonomously functioning thyroid lesions . Am J Med 1975;;58:740-748.
Miller JM, Hamburger JI:  The thyroid scintigram: I. The hot nodule . Radiology 1965;; 84:66-74.
Hoffman DP, Surks MI, Oppenheimer JH, et al:  Response to thyrotropin-releasing hormone: An objective criterion for the adequacy of thyrotropin suppression therapy . J Clin Endocrinol Metab 1977;;44:892-901.
Johnson PM:  Thyroid and whole-body scanning , in Werner SC, Ingbar SH (eds): The Thyroid , ed 4. New York, Harper & Row Publishers Inc, 1978;, p 306.

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Hollander CS, Mitsuma T, Nihei N, et al:  T-3 toxicosis: Clinical and laboratory observations on 40 patients with documentation by radioimmunoassay . Lancet 1972;;1:609-611.
Hershman JM, Pittman JA Jr:  Response to synthetic thyrotropin-releasing hormone in man . J Clin Endocrinol Metab 1970;;31:457-460.
Hershman JM:  Clinical application of thyrotropin-releasing hormone . N Engl J Med 1974;; 290:886-890.
Werner SC, Spooner M:  A new and simple test for hyperthyroidism employing L-triiodothyronine and the 24-hour I-131 uptake method . Bull NY Acad Med 1955;;31:137-145.
Silver S: Radioactive Isotopes in Medicine and Biology (Medicine) , ed 2. Philadelphia, Lea & Febiger Inc, 1962;, p 52.
Blum M, Shenkman L, Hollander CS:  The autonomous nodule of the thyroid: Correlation of patient age, nodule size and functional status . Am J Med Sci 1975;;269:43-50.
Ridgeway ES, Weintraub BD, Cevallos JL, et al:  Suppression of pituitary TSH secretion in the patient with a hyperfunctioning thyroid nodule . J Clin Invest 1973;;52:2783-2792.
Burke G:  The triiodothyronine suppression test . Am J Med 1967;;42:600-608.
Hamburger JI:  Solitary autonomously functioning thyroid lesions . Am J Med 1975;;58:740-748.
Miller JM, Hamburger JI:  The thyroid scintigram: I. The hot nodule . Radiology 1965;; 84:66-74.
Hoffman DP, Surks MI, Oppenheimer JH, et al:  Response to thyrotropin-releasing hormone: An objective criterion for the adequacy of thyrotropin suppression therapy . J Clin Endocrinol Metab 1977;;44:892-901.
Johnson PM:  Thyroid and whole-body scanning , in Werner SC, Ingbar SH (eds): The Thyroid , ed 4. New York, Harper & Row Publishers Inc, 1978;, p 306.
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