Management of the hot thyroid nodule.
BACKGROUND
Solitary hyperfunctioning nodules of the thyroid gland are usually viewed as benign. They may present with autonomous euthyroidism but are of concern for potential progression to hyperthyroidism. Various methods of treatment are worthy of consideration.


METHODS
Forty-five patients with solitary hot thyroid nodules verified by radioisotope scintiscanning were selected for treatment. Thirty-one underwent surgery, usually partial thyroidectomy. Eight euthyroid patients received no treatment, 5 underwent therapy with radioactive iodine (RAI), and 1 received thyroid suppression treatment. The cases were assessed retrospectively.


RESULTS
Thyroidectomy patients had no morbidity, were well, and showed 1 Hürthle cell tumor and 5 coincidental small malignancies associated with benign hot nodules, including a contralateral cancer. Untreated patients showed continuance of good health, but nodules persisted and 1 Graves' orbititis occurred. The RAI-treated patients had persistent nodularity, improved function, and 1 case of hyperparathyroidism. Thyroid feeding only caused iatrogenic toxicity and was discontinued.


CONCLUSIONS
There are various techniques for managing the hot nodule. Nonsurgical methods may be effective, but can result in persistent nodularity and iatrogenic sequelae. Excision had no morbidity in this series and was effective in providing immediate relief of problems present and potential.
D000230:Adenocarcinoma / Q000473:pathology; D018263:Adenocarcinoma, Follicular / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006111:Graves Disease / Q000473:pathology; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology; D006980:Hyperthyroidism / Q000473:pathology; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D013670:Sodium Pertechnetate Tc 99m; D013964:Thyroid Neoplasms / Q000473:pathology; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000628:therapy*; D013965:Thyroidectomy / Q000379:methods; D013974:Thyroxine / Q000627:therapeutic use; D014284:Triiodothyronine / Q000627:therapeutic use
D007457:Iodine Radioisotopes; D014284:Triiodothyronine; D013670:Sodium Pertechnetate Tc 99m; D013974:Thyroxine