Endocrinology Research and Practice
Original Article

Advanced Age and Mild Thyrotoxicosis are Associated with Nodular Goiter in Graves Disease - Original Article


Dokuz Eylul University, School of Medicine, Division of Endocrinology and Metabolism, Department of Internal Medicine, İzmir, Turkey


Dokuz Eylül University Medical School, Department of Internal Medicine, Division of Endecrinology and Metabolism, Izmir, Turkey


Dokuz Eylul University, School of Medicine, Department of Surgery, İzmir, Turkey


Dokuz Eylul University, School of Medicine, Department of Nuclear Medicine, İzmir, Turkey


Dokuz Eylul University, School of Medicine, Department of Pathology, İzmir, Turkey


Dokuz Eylül University Medical School, Division of Endocrinology, İnciraltı, Izmir

Endocrinol Res Pract 2009; 13: 1-4
Read: 1215 Downloads: 352 Published: 01 March 2009

 The primary goal of this study is to evaluate predictors of nodular goiter in Graves Disease (GD).
Materials and Methods: A total of 202 consecutive patients (mean age: 45; 145 female, 57 male) were enrolled. All patients were treated with antithyroid drugs as initial therapy. TSH, FT3, FT4, TRAb, ATPO, and ATG were measured. Radioactive iodine uptake and thyroid ultrasonography were performed, and thyroid volume and nodule diameter were assessed. Ultrasound-guided fine needle aspiration was performed on thyroid nodules ≥8mm.
Results: Diffuse goiter was detected in 51% of patients. Solitary nodules were detected in 16%, and multi-nodular disease in 33%. Mean nodule diameter was 8.82 mm. Nodular disease was slightly more common in women (p=0.063). Patients with nodular GD were older (p=0.004), had lower levels of FT3 (p=0.016) and TRAB (p=0.002) when compared with subjects with diffuse GD. Age (OR:6.867) was the independent variable predicting nodular GD.
Conclusion: Increased prevalence of nodules was associated with advanced age and milder thyrotoxicosis. Apoptosis of thyroid follicular cells due to excess iodine might interfere with nodule formation, and lead to diffuse goiter in severe thyrotoxicosis. Because of increased rate if malignancy in GD, comprehensive evaluation of thyroid nodules of any size is mandatory. 


EISSN 2822-6135