Atlas of Head and Neck Endocrine Disorders by Luca Giovanella Giorgio Treglia & Roberto Valcavi

Author:Luca Giovanella, Giorgio Treglia & Roberto Valcavi
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Fig. 7.5Hyperfunctioning thyroid nodule (arrow) incidentally detected by fluorine-18 fluorodeoxyglucose positron tomography/computed tomography (18F-FDG PET/CT) as focal area of increased thyroid uptake in the right thyroid lobe. This focal uptake pattern is not specific for thyroid autonomy but it may represent a thyroid tumor in about one third of cases

7.3 Therapy

Radioiodine and surgery are the two most effective treatment options for permanently decreasing the production of thyroid hormone [4, 5]. Antithyroid drugs decrease thyroid hormone production but do not induce remission (i.e., discontinuation results in recurrence of hyperthyroidism). Thioamides are often used to treat hyperthyroidism in patients with unifocal or multifocal autonomy in preparation for definitive radioiodine treatment or surgery. However, in patients with increased surgical risk and/or inability to comply with radiation safety guidelines, long-term treatment with thioamides is an option. Radioiodine is given as primary therapy to most patients with AFTN while surgery is generally indicated for patients with obstructive goiters or very large goiters, those who need rapid and definitive correction of hyperthyroidism, and patients with coexisting malignancy or primary hyperparathyroidism. Surgery could also be considered in patients with coexistent nonfunctioning nodules, especially if the goiters are large. Ultrasound-guided percutaneous ethanol injection, interstitial laser photocoagulation or radiofrequency ablation were also evaluated with sparse results and their use is not recommended in daily clinical practice.

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