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FUAD S. ASHKAR, MD; William M. Smoak III, MD
Miami, Fla

JAMA. 1970;214(8):1563.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

In 1913, Plummer differentiated diffuse toxic goiter from toxic autonomous nodular goiter on the basis of observation on 2,000 patients who underwent operations.¹ The autonomous nodular goiter presents a special diagnostic problem in its toxic and pretoxic stages, because of the existence in it of inactive thyroid tissue that gives a "cold" appearance in the scintigram. The nodules are variable in size, most of them are larger than the surrounding suppressed normal tissue, and in cross section represent a group of variable-sized, functioning follicles.² Functional capacity of these autonomous nodules is limited in comparison to diffuse toxic disease, toxicity is only produced after a dimension of three to four cm is reached.^2,3

A new area of suppressed function was noted by our group in the autonomous nodular goiter; it occurs usually in a central position in the autonomous nodule (Fig 1 and 2). This . . . [Full Text PDF of this Article]

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