Editing Hyperthyroidism (section)

== '''Toxic single adenoma''' ==

* Single benign monoclonal     thyroid tumours that autonomously oversecrete thyroid hormone, existing     within an otherwise normal or non-toxic nodular thyroid gland
* Risk factors
** Mild female predominance
** Median age 50-60yo
* Pathophysiology
** Constitutively active      mutations in the TSH receptor gene
** Usually >3cm
** Evolves through a course of      subclinical to clinical hyperthyroidism
** Virtually never malignant
* Workup
** As per Toxic MNG
* Treatment
** Antithyroid drugs - seldom      if ever chosen, as recurrence is guaranteed, and remission does not occur
** Radioactive iodine -      effective, and euthyroidism is re-established in 80% with a single dose.      Not ok in pregnancy/lactation. Can have recurrence.
** Surgery - virtually 100%      effective
*** Can be unilateral       thyroidectomy, unless bilateral suspicious nodules and/or symptomatic       goitre
** Percutaneous ablative      techniques
*** Either ethanol or RFA
*** Requires much further study       before being accepted - not very well understood currently with decent       complication rate