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Autonomously functioning thyroid nodule: a patient-based review

Authors:

Diluka Pinto ,

University of Kelaniya,, LK
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Ranil Fernando

University of Kelaniya,, LK
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Abstract

Autonomously Functioning Thyroid Nodule (AFTN) is a rare
cause of hyperthyroidism. AFTN, first described by Emil
Goetsch in 1918, is the presence of a single hyperfunctioning
thyroid nodule, which is not under the control of the
pituitary/thyroid axis.
The current theory on the development of hyperfunctioning
nodules is the constitutive activation of Thyroid Stimulating
Hormone Receptor (TSHR) due to a somatic point mutation
and mutations of Gsa.
The reported incidence of AFTN is about 1% on the
investigation of thyroid nodules. Only about 10% - 30%
become hyperfunction. Due to the rarity and lack of
understanding of its characteristic clinical behaviour, AFTNs
are often overlooked and undertreated. The ensuing review is
based on a 36-year-old female who underwent left
hemithyroidectomy for an AFTN and is well to date.
There are two main issues in the diagnosis and management
of AFTN. The first is that the diagnosis is not always made as
most patients with AFTNs are functionally euthyroid. The
other is the paucity of data in the literature to offer evidence-
based individualized management for patients.
As there are no tissue diagnostic criteria for AFTN; clinical,
biochemical and radiological assessments to establish TSH
independent nodular hyperfunction will clinch the diagnosis.
Surgery and Radioiodine ablation remain the main forms of
treatment for AFTN. Other methods such as percutaneous
ethanol injection therapy (PEIT), laser ablation (LA),
radiofrequency ablation (RFA) have a limited role in the
management of an AFTN. The newer methods alluded to
above will need further evaluation and a better definition of
exact roles in the management of an AFTN.

How to Cite: Pinto D, Fernando R. Autonomously functioning thyroid nodule: a patient-based review. Sri Lanka Journal of Surgery. 2021;39(3):49–54.
Published on 30 Nov 2021.
Peer Reviewed

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