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In this section only autonomous nodules, that is hot nodules with
uptake in the nodule and various degrees of extranodular suppression, are considered. Cold
solitary nodules are not believed to take up 131I to any significant degree and are
therefore not treated with 131I. On the other hand it is evident from the treatment of
multinodular non-toxic goitre that also areas with seemingly low/no uptake are reduced by
131I-therapy. In theory, reduction by 131I of cold nodules should be possible, however, no
objective data on this is available.
Most subjects with autonomous non-toxic thyroid nodules have a suppressed s-TSH at time of diagnosis (subclinical hyperthyroidism). Most of these nodules do not substantially change in size with time, 86% remained stable during a follow-up period of 1–15 years (37). 5% become hyperthyroid each year (37). At this time the nodule is usually 3 cm or more in diameter. Since many subjects have pressure symptoms, cosmetic complaints and subclinical hyperthyroidism – associated with increased morbidity – a number of centres (including ours) choose to recommend 131I-therapy to these subjects without waiting for clinical hyperthyroidism to occur. |
