The Natural History of the Autonomous Hyperfunctioning Thyroid Nodule

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Abstract
Nine patients with autonomous thyroid nodules were studied for periods ranging from 2-7 yr., with a mean follow-up of 4 yr. Autonomy was confirmed by T [triiodothyronine]3-suppression and TSH[thyroid-stimulating hormone]-stimulation tests. All nodules were initially shown to be "hot" with apparent complete suppression of endogenous TSH production. None of these patients developed hyperthyroidism during the study period. Serial studies during the follow-up period indicate considerable variability in the ultimate status of these nodules. The initial pattern of autonomy in a "hot" nodule persisted for up to 7 yr. in 4 patients. In 1 patient follow-up studies demonstrated transition from a "hot" to a "warm" nodule with evidence of I131 accumulation in extra-nodular areas of the gland, although the nodule itself remained autonomous. Re-establishment of "partial" TSH-dependence was seen in 3 patients. Degeneration in the nodule with apparent return of a normal pituitary-thyroid axis was observed in 1 case. These disparate findings were independent of the time-course of study and demonstrate a marked variability in the evolution of the autonomous hyperfunctioning thyroid nodule.

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