Toxic Adenoma natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

If left untreated, some of the patients with toxic adenoma may progress to develop thyrotoxicosis which increases the risks of atrial fibrillation, heart failure, and decreased bone mineral density in postmenopausal women (osteoporosis). Common complications of toxic adenoma include atrial fibrillation, neck compression, bone mineral loss, thyroid storm, I-131-related hypothyroidism. Prognosis of toxic adenoma is generally good with treatment. About 45% to 75% of patients stay euthyroid following I-131 therapy.

Natural History

If left untreated, some of the patients with toxic adenoma may progress to develop thyrotoxicosis.^[1]^[2]
Nodule size is a strong predictor of whether thyrotoxicosis will develop in solitary adenomas.
Most autonomously functioning thyroid nodules that become thyrotoxic are larger than 2.5 to 3 cm in diameter.
Consequences of untreated toxic multinodular goiter are due to hyperthyroidism or thyrotoxicosis which includes increased risks of atrial fibrillation, heart failure, and decreased bone mineral density in postmenopausal women.
Spontaneous resolution of a toxic adenoma can occur very rarely because of hemorrhage, cystic degeneration, and loss of autonomous function.

Complications

Complications of toxic adenoma are mainly due thyrotoxicosis which includes a constellation of symptoms and signs caused by excess circulating and tissue free triiodothyronine (T3 ), free thyroxine (T4 ), or both. These result in hypermetabolism and other excessive tissue-specific thyroid hormone effects. Common complications of toxic adenoma include:^[3]

Atrial fibrillation
Heart failure
Facial plethora
Inspiratory stridor
Hoarseness
Dysphagia
Bone mineral loss
Thyroid storm
I-131-related hypothyroidism
Surgery-related
Antithyroid drug-related agranulocytosis

Prognosis

Prognosis of toxic adenoma is generally good with treatment.
About 45% to 75% of patients stay euthyroid following I-131 therapy.
Both surgery and radioactive iodine therapy can confer a moderate long-term risk of hypothyroidism.^[4]^[5]

References

↑ Parle JV, Maisonneuve P, Sheppard MC, Boyle P, Franklyn JA (2001). “Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year cohort study”. Lancet. 358 (9285): 861–5. doi:10.1016/S0140-6736(01)06067-6. PMID 11567699.
↑ Pearce EN, Braverman LE (2004). “Hyperthyroidism: advantages and disadvantages of medical therapy”. Surg. Clin. North Am. 84 (3): 833–47. doi:10.1016/j.suc.2004.01.007. PMID 15145238.
↑ Ertek S, Cicero AF (2013). “Hyperthyroidism and cardiovascular complications: a narrative review on the basis of pathophysiology”. Arch Med Sci. 9 (5): 944–52. doi:10.5114/aoms.2013.38685. PMC 3832836. PMID 24273583.
↑ Erdoğan MF, Küçük NO, Anil C, Aras S, Ozer D, Aras G, Kamel N (2004). “Effect of radioiodine therapy on thyroid nodule size and function in patients with toxic adenomas”. Nucl Med Commun. 25 (11): 1083–7. PMID 15577585.
↑ Hegedüs L (2004). “Clinical practice. The thyroid nodule”. N. Engl. J. Med. 351 (17): 1764–71. doi:10.1056/NEJMcp031436. PMID 15496625.

[pmid11567699-1] Parle JV, Maisonneuve P, Sheppard MC, Boyle P, Franklyn JA (2001). “Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year cohort study”. Lancet. 358 (9285): 861–5. doi:10.1016/S0140-6736(01)06067-6. PMID 11567699.

[pmid15145238-2] Pearce EN, Braverman LE (2004). “Hyperthyroidism: advantages and disadvantages of medical therapy”. Surg. Clin. North Am. 84 (3): 833–47. doi:10.1016/j.suc.2004.01.007. PMID 15145238.

[pmid24273583-3] Ertek S, Cicero AF (2013). “Hyperthyroidism and cardiovascular complications: a narrative review on the basis of pathophysiology”. Arch Med Sci. 9 (5): 944–52. doi:10.5114/aoms.2013.38685. PMC 3832836. PMID 24273583.

[pmid15577585-4] Erdoğan MF, Küçük NO, Anil C, Aras S, Ozer D, Aras G, Kamel N (2004). “Effect of radioiodine therapy on thyroid nodule size and function in patients with toxic adenomas”. Nucl Med Commun. 25 (11): 1083–7. PMID 15577585.

[pmid15496625-5] Hegedüs L (2004). “Clinical practice. The thyroid nodule”. N. Engl. J. Med. 351 (17): 1764–71. doi:10.1056/NEJMcp031436. PMID 15496625.

[1]

[2]

[3]

[4]

[5]