Management of Toxic Multinodular Goitre and Toxic Adenoma

Toxic adenoma (TA) and toxic multinodular goitre (TMNG) represent the clinically important presentations of thyroid autonomy. Thyroid autonomy is a condition where thyrocytes produce thyroid hormones independently of thyrotropin (TSH) and in absence of TSH receptor stimulating antibodies (TSAb). This prevalence of thyroid autonomy is linked with dietary iodine supply and is a common finding in areas with iodine deficiency. Genetic alterations frequently determined in patients with TA or TMNG are activating somatic mutations in the TSH receptor or the Gs alpha protein subunit resulting in a loss of pituitary control of the thyroid. This chapter discusses beside epidemiology and pathology also the clinical presentation, diagnosis, and treatment options for patients with TA or TMNG.