Thyroid Case 6 Answers

1) What are the findings?

The thyroid gland is enlarged and demonstrates very heterogeneous uptake with patchy areas of increased and decreased uptake

2) What is the diagnosis?

This is the typical appearance of a multinodular goitre. When it is associated with hyperthyroidism, it is known as a toxic (multi)nodular goitre (TNG), reflecting autonomous hypersecretion of thyroxine by one or more nodules

3) What is the eponymous name of this condition, and can you name any other conditions which carry the same eponym?

TNG carries the eponym Plummer’s disease after Henry Stanley Plummer, an endocrinologist at the Mayo Clinic who named the condition in 1913. He also co-described Plummer-Vinson syndrome, the rare association of iron deficiency anaemia with a pharyngeal web

4) What proportion of cases of hyperthyroidism are caused by this condition?

This is the second commonest cause of hyperthyroidism after Graves disease, accounting for 15-30% of cases overall. However, in areas of endemic iodine deficiency it can account for up to 60% of cases. Although the vast majority of patients with multinodular goitre are euthyroid, there is a general slow trend towards hyperthyroidism over time

5) Are there any specific complications of CT examinations for patients with this disorder?

The iodine load associated with iodinated contrast medium (or drugs such as amiodarone) can cause overt thyrotoxicosis in euthyroid or mildly hyperthyroid patients with multinodular goitre – this is known as the Jod-Basedow phenomenon

Contributed by Ian Hagan

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The text is entirely the opinion of the author and does not necessarily reflect that of RUH NHS Trust or the Bristol Radiology Training Scheme. Website content devised by Paul McCoubrie.