The Autonomous Functioning Thyroid Nodule in the Evolution of Nodular Goiter

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Abstract
Autoradiographic studies of the thyroids of 21 patients with a gross autonomous functioning nodule demonstrated similar small or micronodules in 76 %. They were also present in 4 glands in which a large cyst was the dominant nodule. In only 14 % of 29 patients with nonfunctioning macronodules were these tiny functioning nodules found. These data suggest that hot macronodules evolve with secretory activity from their origin, but they do not support the hypothesis of a common functional stage for all nodules. Transition from a functioning to a nonfunctioning nodule may occur through degenerative change or possibly by simple loss of functional capacity of the follicles. The appearance of the latter change in our series does not suggest that it can account for a large number of cold nodules. The histologic appearance of the smallest observed functioning nodules has been found to be that previously thought to be associated with the absorption of colloid from a large follicle and the ultimate partition of this follicle into smaller ones in a thyroid under unusual stimulation. The significance of this finding has yet to be determined.