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Functional Autonomy in Multinodular Goiter
J. Martin Miller, MD;
Melvin A. Block, MD
JAMA. 1970;214(3):535-539.
Abstract
Forty-six of 70 patients with large multinodular goiters had significant radioactive iodine uptake after liothyromine sodium (T3) administration. The scintiscan patterns during suppression were comparable to those of 49 patients with similar goiters and non-Graves' hyperthyroidism. The distribution of radioactive iodine uptake varied from localization in one of the many nodules to a patchy but diffuse picture which microscopically involved several types of follicular architecture. It is hypothesized that the gradual increment of the autonomous tissue causes transition from a euthyroid to a hyperthyroid state based on gland autonomy rather than on a humoral stimulator. Autonomous function must be suspected in all large multinodular goiters and evaluated before levothyroxine sodium treatment. If such function is present, a "replacement" dose of thyroid hormone will actually be an additive one, and hyperthyroidism may be produced.
Author Affiliations
From the divisions of endocrinology (Dr. Miller) and general surgery (Dr. Block), Henry Ford Hospital, Detroit.
Footnotes
Reprint requests to 2799 W Grand Blvd, Detroit 48202 (Dr. Miller).
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