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

Abstract
Objective: 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.