CHOICE OF TREATMENT IN SOLITARY, FUNCTION ALLY AUTONOMOUS THYROID NODES WITH HYPERTHYROIDISM

Over the last 20 years, unifocal functionally autonomous nodes (UFA) o f the thyroid have accounted for more than one third of all patients w ith hyperthyroid;ism in the former iodine-deficient and goiter-endemic region of Bern. This situation calls for a special diagnostic approac h, i.e. etiologic diagnosis of any solitary nodule and careful conside ration of therapy in contrast to regions with iodine excess where UFA is very rare, such as the USA. Therapy is recommended even where hyper thyroidism is still latent (blocked TRH test, normal TT3 and TT4) and reliably leads to subjective and objective improvement even in oligosy mptomatic individuals. The safe and easy radioiodine therapy (RIT) is preferred in elderly patients with associated conditions. Surgical res ection is recommended chiefly where malignancy is suspected or RIT is technically inappropriate. Both methods produce prompt eradication of the source of hyperthyroidism. The most frequent complication is hypot hyroidism requiring lifelong follow-up.