Physiologic considerations in the genesis and management of nodular goiter

Taylor, Mr.Selwyn

doi:10.1016/0002-9343(56)90152-8

Cited by 25 publications

(8 citation statements)

References 78 publications

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“…The fact that our patients were a surgical series with relatively Large goitres and a predominance of multinodular forms of long duration may well explain the discrepancy in frequency. That goitrous tissue may show increasing autonomous behaviour is supported by autoradiographic studies (18), and scintigraphic findings demonstrating subnormal suppressibility of the goitrous gland by T3 (3, 10, 12). From two of these studies (3, 12) it also appears that autonomously functioning tissue may not be confined to nodules, but may show a variable internodular distribution as well.…”

Section: Discussionmentioning

confidence: 84%

TSH Response Pattern to TRH Test and Optimum Time of Blood Sampling in Sporadic Euthyroid Goitre

Blichert-Toft

Christiansen

Axelsson

et al. 1978

Journal of Internal Medicine

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ABSTRACT. Attempts were made to estimate the response pattern of thyrotrophin (TSH) to thyrotrophin‐releasing hormone (TRH) and the optimum time of blood sampling in patients with sporadic euthyroid goitre. Of the 65 subjects studied, 21 served as a reference group and 44 were patients with sporadic euthyroid goitres, divided into diagnostic subgroups according to type of goitre. Patients with a single autonomous thyroid adenoma were excluded. The classification of goitre was based on clinical features, thyroid function tests, thyroid imaging studies using 99mTc pertechnetate uptake, and examination of thyroid specimens originating from selective goitre resection carried out after the laboratory investigations. A standardized i.v. TRH test was performed in all probands and the TSH response was followed for 60 min postinjection. There was a definite trend towards lack of response with increasing nodularity of the thyroid gland. Moreover, no further information concerning the TSH response pattern was achieved by extending the blood sampling period beyond the +2 min limit of the time axis. The study lends support to the view that increasing functional autonomy is a general trend in goitre evolution.

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Section: Discussionmentioning

confidence: 84%

TSH Response Pattern to TRH Test and Optimum Time of Blood Sampling in Sporadic Euthyroid Goitre

Blichert-Toft

Christiansen

Axelsson

et al. 1978

Journal of Internal Medicine

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“…Characteristically, in this latter group, the goitrous tissue on the scintigram reveals a patchy uptake with areas showing varying predominance of nonfunctioning nodules (Gemsenjager et al, 1976). Based on autoradiographic and in vivo scintigraphic studies it appears that autonomously functioning tissue may not only be confined t o visible nodules (pattern 1 and 2 ; Miller & Block, 1970), but may also show a variable internodular distribution (pattern 3 and 4; Miller & Block, 1970;Taylor, 1956;Dige-Petersen et al, 1976). Accordingly, differences in scintigraphic appearance in euthyroid goitrous patients showing TRH refractoriness seem to be explained by the variability in relative distribution of autonomous tissue in nodular and internodular compartments.…”

Section: Discussionmentioning

confidence: 97%

“…It is considered that in later stages of the natural history of goitre evolution, increasing autonomous behaviour of goitrous tissue appears. Autoradiographic studies of goitrous tissue (Taylor, 1956) and scintigraphic findings demonstrating subnormal suppressibility of the goitrous gland by T3 lend further support to this view (Miller & Block, 1970;Dige-Petersen et al, 1976).…”

mentioning

confidence: 85%

Effect of Selective Goitre Resection on Absent Thyrotrophin Response to Thyrotrophin Releasing Hormone in Idiopathic Euthyroid Goitres

Blichert-Toft

Christiansen

Axelsson

et al. 1978

Clinical Endocrinology

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Absent thyrotrophin (TSH) response to thyrotrophin releasing hormone (TRH) was found in ten of fifty consecutive nodular goitrous patients who were clinically and biochemically euthyroid. These ten patients together with a reference group engaging fifty-eight healthy individuals matched for sex, age, and geographic region form the basis of the present study. Patients with autonomously functioning single adenomata were excluded from the investigation. In the patient group, values of serum thyroxine (T4), free T4-index, and serum TSH did not differ significantly from those recorded in the reference group, whereas serum triiodothyronine was found to be significantly higher in the patients, although within the normal range. After selective resection of the goitre, the TSH responsiveness to TRH recovered completely. Routine indices of thyroid function, however, demonstrated no major deviation from pre-operative levels. During a follow-up period of 1 year, no systematic alterations were recorded in TSH response to TRH nor in the thyroid function tests, indicating maintenance of euthyroidism with restored normality within the pituitary-thyroid axis. The present study lends support to the view that increasing functional autonomy apparently is a common trend in goitre evolution in a non-endemic area.

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“…Resorption of colloid or follicular necrosis causes a reduction in the blood supply, eventually resulting in fibrosis and degeneration of the nodule. In this setting, levothyroxine suppressive therapy will not influence the pathologic processes within the nodule [26,27]. A number of other factors, including epidermal growth factor [28], insulin-like growth factor [29] and thyroid stimulating immunoglobulins [29], have been suggested to induce the growth of thyroid nodules.…”

Section: Discussionmentioning

confidence: 99%

Role of levothyroxine suppressive therapy for benign cold nodules of thyroid: a randomized, double-blind, placebo-controlled clinical trial

Larijani¹,

Pajouhi²,

Bastanhagh³

et al. 2005

Therapy

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Physiologic considerations in the genesis and management of nodular goiter

Cited by 25 publications

References 78 publications

TSH Response Pattern to TRH Test and Optimum Time of Blood Sampling in Sporadic Euthyroid Goitre

TSH Response Pattern to TRH Test and Optimum Time of Blood Sampling in Sporadic Euthyroid Goitre

Effect of Selective Goitre Resection on Absent Thyrotrophin Response to Thyrotrophin Releasing Hormone in Idiopathic Euthyroid Goitres

Role of levothyroxine suppressive therapy for benign cold nodules of thyroid: a randomized, double-blind, placebo-controlled clinical trial

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