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Autonomous Thyroid Nodules. I. A Clinical Classification and the Use of a Diagnostic Index

Hospital das Clínicas, University of São Paulo Medical School, and the Radioisotope Laboratory, Institute of Atomic Energy, São Paulo, Brazil

Correspondence: For reprints contact: Geraldo A. Medeiros-Neto, Hospital das Clínicas, Caixa Postal-8091, São Paulo, Brasil.

ABSTRACT

The authors studied 100 patients with an ATN, divided into three main groups according to the incidence of clinical symptoms and signs suggesting thyrotoxicosis. A diagnostic index based on findings normally obtained during the medical examination was found useful for the classification of these patients and correlated with laboratory data. A DI below 9 suggests euthyroidism and one over 12 is compatible with thyrotoxicosis. Thirty-four patients with a DI below 9 (Group A) had a mean PBI value of 5.48 µg/100 ml and a mean 24-hr RAI uptake of 42.4%. Twenty-eight patients with a DI between 9 and 12 (Group B) had a mean PBI of 7.68 µg and a mean 24-hr uptake of 50.86%. Thirty-eight patients with a DI over 12 (Group C) had a mean PBI of 9.97 µg and a mean 24-hr uptake of 63.2%. In all three groups the T₃ suppression test showed no significant change, although in Groups A and B the mean value of the 24-hr RAI uptake was lower after T₃ suppression than with control values. In five patients of Group B there was a definite decrease in the relative plasma concentration of labeled thyroid hormones during exogenous T₃ administration. It was concluded that in patients of Groups A and B a certain amount of synthesis and production of thyroid hormones occurred in nodular and the paranodular tissues under stimulation by pituitary TSH. This was not observed in patients of Group C, where presumably endogenous TSH secretion was completely abolished. A higher sensitivity of the nodular tissue to the presumably minute amounts of plasma TSH was postulated to explain these results. It was suggested that patients in Group C represent an advanced stage of the same disease which is present in patients from Groups A and B.