Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0256
C. Hendrieckx, J. Speight
Type 1 diabetes is a demanding, complex lifelong condition. Optimal self-care involves repetitive behavioural tasks, undertaken ‘24/7’: administering multiple daily insulin doses, adjusted for food/activity and monitoring glucose levels to avoid hyper- and hypoglycaemia. This requires a comprehensive understanding of diabetes, as well as healthy coping, resilience, problem-solving, and risk reduction skills. It is unsurprising that many experience emotional distress as a consequence of living with type 1 diabetes, which impacts not only on their well-being but also on self-management and outcomes. Clinical guidelines acknowledge that diabetes affects both physical and emotional health. However, the misguided perception persists that the psychosocial care is separate from the diabetes care, and that it requires mental health specialists to assist. A paradigm shift is needed. Diabetes health professionals need to enhance their consultation skills to identify and address psychological needs, if they are to support people to live well with this challenging condition.
{"title":"Psychological and Behavioural Aspects of Type 1 Diabetes Management","authors":"C. Hendrieckx, J. Speight","doi":"10.1093/med/9780198870197.003.0256","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0256","url":null,"abstract":"Type 1 diabetes is a demanding, complex lifelong condition. Optimal self-care involves repetitive behavioural tasks, undertaken ‘24/7’: administering multiple daily insulin doses, adjusted for food/activity and monitoring glucose levels to avoid hyper- and hypoglycaemia. This requires a comprehensive understanding of diabetes, as well as healthy coping, resilience, problem-solving, and risk reduction skills. It is unsurprising that many experience emotional distress as a consequence of living with type 1 diabetes, which impacts not only on their well-being but also on self-management and outcomes. Clinical guidelines acknowledge that diabetes affects both physical and emotional health. However, the misguided perception persists that the psychosocial care is separate from the diabetes care, and that it requires mental health specialists to assist. A paradigm shift is needed. Diabetes health professionals need to enhance their consultation skills to identify and address psychological needs, if they are to support people to live well with this challenging condition.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134250117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0228
B. White, R. Viner
The management of obesity in childhood and adolescence poses challenges unique to this age group. Compared to adults, obesity-related comorbidities are relatively rare, yet risk factors are increasingly prevalent, frequently undetected, and poorly managed. The evidence base for weight loss interventions and management of comorbidities is limited, with short duration of follow-up only reported, and few randomized controlled trials. Bariatric surgery in adolescents results in the largest magnitude of weight loss, with outcomes similar to those seen in adults. Lifestyle intervention studies have relatively modest outcomes, with unknown long-term outcomes. Only one pharmaceutical agent (orlistat) is licenced in this age group, with generally poor outcomes.
{"title":"Management of Obesity in Children and Young People","authors":"B. White, R. Viner","doi":"10.1093/med/9780198870197.003.0228","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0228","url":null,"abstract":"The management of obesity in childhood and adolescence poses challenges unique to this age group. Compared to adults, obesity-related comorbidities are relatively rare, yet risk factors are increasingly prevalent, frequently undetected, and poorly managed. The evidence base for weight loss interventions and management of comorbidities is limited, with short duration of follow-up only reported, and few randomized controlled trials. Bariatric surgery in adolescents results in the largest magnitude of weight loss, with outcomes similar to those seen in adults. Lifestyle intervention studies have relatively modest outcomes, with unknown long-term outcomes. Only one pharmaceutical agent (orlistat) is licenced in this age group, with generally poor outcomes.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"162 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133671397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0107
W. Dhillo, P. Bech
Neuroendocrine cells occur throughout the body, they are particularly prominent in the gastrointestinal tract, pancreas, C cells of the thyroid, adrenal medulla, parathyroid tissue, respiratory tract, skin, and genitourinary system. Neuroendocrine cells are characterized by the presence of dense core secretory vesicles in the cytoplasm which are used to store, process, and secrete hormones. Neuroendocrine tumours (NETs) occur in all these tissues. Due to thseir rarity, heterogeneity, varied and vague symptoms, and often slow-growing tumours, NETs can be a diagnostic challenge. Tumour biomarkers are required for diagnosis and follow-up. An ideal NET biomarker would be one that is secreted exclusively by the tumour cells and can be used for screening, prognostic indication, estimation of tumour burden, and surveillance. Although none of the currently available biomarkers completely fits this ideal, when measured in combination, they are useful for diagnosis, monitoring response to therapy and surveillance. Due to NET defective processing of pro-hormones, any new biomarker should also be able to detect these aberrant forms to increase the sensitivity of the test.
{"title":"Neuroendocrine Tumour Markers","authors":"W. Dhillo, P. Bech","doi":"10.1093/med/9780198870197.003.0107","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0107","url":null,"abstract":"Neuroendocrine cells occur throughout the body, they are particularly prominent in the gastrointestinal tract, pancreas, C cells of the thyroid, adrenal medulla, parathyroid tissue, respiratory tract, skin, and genitourinary system. Neuroendocrine cells are characterized by the presence of dense core secretory vesicles in the cytoplasm which are used to store, process, and secrete hormones. Neuroendocrine tumours (NETs) occur in all these tissues. Due to thseir rarity, heterogeneity, varied and vague symptoms, and often slow-growing tumours, NETs can be a diagnostic challenge. Tumour biomarkers are required for diagnosis and follow-up. An ideal NET biomarker would be one that is secreted exclusively by the tumour cells and can be used for screening, prognostic indication, estimation of tumour burden, and surveillance. Although none of the currently available biomarkers completely fits this ideal, when measured in combination, they are useful for diagnosis, monitoring response to therapy and surveillance. Due to NET defective processing of pro-hormones, any new biomarker should also be able to detect these aberrant forms to increase the sensitivity of the test.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132328568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0282
B. Vergès
Diabetic dyslipidaemia plays an important role in the increased cardiovascular risk of type 2 diabetes. It encompasses not only quantitative lipoprotein abnormalities, but also qualitative and kinetic abnormalities that, together, result in a shift toward a more atherogenic lipid profile. The principal quantitative lipoprotein abnormalities are increased triglyceride levels and decreased high-density lipoprotein (HDL) cholesterol levels. Qualitative lipoprotein abnormalities include increases in large, very low-density lipoprotein subfraction 1 (VLDL1) and small, dense low-density lipoproteins (LDLs), increased triglyceride content of LDLs and HDLs, glycation of apolipoproteins, and increased susceptibility of LDLs to oxidation. Moreover, HDLs from diabetic patients are dysfunctional, having severely reduced antiatherogenic properties. Statin use is recommended in most patients with T2DM because of the cardiovascular benefit demonstrated in many trials. Some post-hoc analyses of trials with fenofibrate suggest a potential CVD reduction in diabetic patients with triglycerides ≥2.6 mmol/L and low HDL cholesterol.
{"title":"Diabetic Dyslipidaemia","authors":"B. Vergès","doi":"10.1093/med/9780198870197.003.0282","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0282","url":null,"abstract":"Diabetic dyslipidaemia plays an important role in the increased cardiovascular risk of type 2 diabetes. It encompasses not only quantitative lipoprotein abnormalities, but also qualitative and kinetic abnormalities that, together, result in a shift toward a more atherogenic lipid profile. The principal quantitative lipoprotein abnormalities are increased triglyceride levels and decreased high-density lipoprotein (HDL) cholesterol levels. Qualitative lipoprotein abnormalities include increases in large, very low-density lipoprotein subfraction 1 (VLDL1) and small, dense low-density lipoproteins (LDLs), increased triglyceride content of LDLs and HDLs, glycation of apolipoproteins, and increased susceptibility of LDLs to oxidation. Moreover, HDLs from diabetic patients are dysfunctional, having severely reduced antiatherogenic properties. Statin use is recommended in most patients with T2DM because of the cardiovascular benefit demonstrated in many trials. Some post-hoc analyses of trials with fenofibrate suggest a potential CVD reduction in diabetic patients with triglycerides ≥2.6 mmol/L and low HDL cholesterol.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116453803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0087
Laleh Ardeshirpour, T. Carpenter, C. Robinson
Mineral requirements vary considerably throughout life, reflecting the intensive mineral accretion that occurs in during childhood. The correct diagnosis of bone and mineral disorders as well as the monitoring of relevant therapies requires an understanding of the age-dependent changes in serum minerals and calciotropic hormones. Many heritable disorders of mineral homeostasis become evident in infancy and childhood and are best recognized when viewed within the appropriate context of mineral requirements and the hormonal milieu during the early stages of life. Thus, an understanding of the relevant physiology is central to formulating age-specific approaches to management of these various clinical problems. This chapter reviews features of calcium homeostasis specific to children, and the diagnosis and management of various inherited and acquired syndromes of hypocalcaemia and hypercalcaemia, in the context of physiology specific to childhood.
{"title":"Hypercalcaemic and Hypocalcaemic Syndromes in Children","authors":"Laleh Ardeshirpour, T. Carpenter, C. Robinson","doi":"10.1093/med/9780198870197.003.0087","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0087","url":null,"abstract":"Mineral requirements vary considerably throughout life, reflecting the intensive mineral accretion that occurs in during childhood. The correct diagnosis of bone and mineral disorders as well as the monitoring of relevant therapies requires an understanding of the age-dependent changes in serum minerals and calciotropic hormones. Many heritable disorders of mineral homeostasis become evident in infancy and childhood and are best recognized when viewed within the appropriate context of mineral requirements and the hormonal milieu during the early stages of life. Thus, an understanding of the relevant physiology is central to formulating age-specific approaches to management of these various clinical problems. This chapter reviews features of calcium homeostasis specific to children, and the diagnosis and management of various inherited and acquired syndromes of hypocalcaemia and hypercalcaemia, in the context of physiology specific to childhood.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"395 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114619224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0113
K. Meeran
Glucagonomas are rare neuroendocrine tumours of the alpha cells of the pancreas that present with a rash and diabetes. There are under five new cases in the United Kingdom each year. The necrolytic migratory erythema presents to dermatologists. Glucagonomas can be benign or malignant in approximately equal proportions. Despite metastatic disease, the usually responds to somatostatin analogues such as octreotide and lanreotide. Tachyphylaxis occurs, so the dose is often increased over the course of the first 2 years. Patients with the gene for multiple endocrine neoplasia type 1 have an increased risk of neuroendocrine tumours of the pancreas including glucagonomas. Because these tumours often express somatostatin receptors, imaging with Gallium 68 labelled dotatate with a PET scan. Treatment choices should be discussed at a multidisciplinary meeting. Patients with uptake on Gallium 68 scanning can be treated with radiolabelled lutetium 177 labelled dotatate. The 5-year survival for patients with glucagonomas is 50–70%.
{"title":"Glucagonoma","authors":"K. Meeran","doi":"10.1093/med/9780198870197.003.0113","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0113","url":null,"abstract":"Glucagonomas are rare neuroendocrine tumours of the alpha cells of the pancreas that present with a rash and diabetes. There are under five new cases in the United Kingdom each year. The necrolytic migratory erythema presents to dermatologists. Glucagonomas can be benign or malignant in approximately equal proportions. Despite metastatic disease, the usually responds to somatostatin analogues such as octreotide and lanreotide. Tachyphylaxis occurs, so the dose is often increased over the course of the first 2 years. Patients with the gene for multiple endocrine neoplasia type 1 have an increased risk of neuroendocrine tumours of the pancreas including glucagonomas. Because these tumours often express somatostatin receptors, imaging with Gallium 68 labelled dotatate with a PET scan. Treatment choices should be discussed at a multidisciplinary meeting. Patients with uptake on Gallium 68 scanning can be treated with radiolabelled lutetium 177 labelled dotatate. The 5-year survival for patients with glucagonomas is 50–70%.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"96 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133844050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0190
H. Gleeson, R. Wright
Healthcare professionals are increasingly aware that the transition from childhood to adulthood requires special consideration, in terms of meeting the needs of young people with any long-term condition, both through healthcare design and delivery and the need for a specific skill and behaviour set in order to do this effectively. Young people can be a forgotten group, not adequately considered in paediatric or adult service development strategies resulting in disrupted care. This phase of life is key, as it is when a young person develops their ideas about, and relationships with the healthcare system and their own health condition, thus setting the scene for future interactions. Young people with endocrine conditions, whether onset is in early childhood or during adolescence, often require lifelong care, and therefore both paediatric and adult healthcare professionals require knowledge about: biopsychosocial development and how it can both affect and be affected by having an endocrine condition; key aspects of adolescent health; developmentally appropriate healthcare; effective transition between paediatric and adult services; endocrine-specific care during adolescence and young adulthood.
{"title":"Transition in Endocrinology","authors":"H. Gleeson, R. Wright","doi":"10.1093/med/9780198870197.003.0190","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0190","url":null,"abstract":"Healthcare professionals are increasingly aware that the transition from childhood to adulthood requires special consideration, in terms of meeting the needs of young people with any long-term condition, both through healthcare design and delivery and the need for a specific skill and behaviour set in order to do this effectively. Young people can be a forgotten group, not adequately considered in paediatric or adult service development strategies resulting in disrupted care. This phase of life is key, as it is when a young person develops their ideas about, and relationships with the healthcare system and their own health condition, thus setting the scene for future interactions. Young people with endocrine conditions, whether onset is in early childhood or during adolescence, often require lifelong care, and therefore both paediatric and adult healthcare professionals require knowledge about: biopsychosocial development and how it can both affect and be affected by having an endocrine condition; key aspects of adolescent health; developmentally appropriate healthcare; effective transition between paediatric and adult services; endocrine-specific care during adolescence and young adulthood.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"49 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133569856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0262
N. Wareham
The rising prevalence of type 2 diabetes and the costs of managing the condition in developed and developing countries alike has driven an increased focus on the potential to design and implement preventive interventions. Meta-analyses of randomized controlled trials of individual-level behavioural interventions aimed at changing dietary and physical activity behaviour, mediated in most but not all populations by weight loss, have unequivocally established that these interventions are efficacious under the ideal circumstances that exist in clinical trials. Achieving comparable effectiveness in real-world settings has been much more challenging and there are as yet few examples of effective, scalable, and inexpensive interventions. Even in settings where individual-level interventions are affordable, such approaches need to be complemented by whole population approaches to prevention that implicitly acknowledge that the public health problem of diabetes cannot be dealt with by clinical approaches alone and needs a balanced approach of individual and societal-level action.
{"title":"Prevention of Type 2 Diabetes","authors":"N. Wareham","doi":"10.1093/med/9780198870197.003.0262","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0262","url":null,"abstract":"The rising prevalence of type 2 diabetes and the costs of managing the condition in developed and developing countries alike has driven an increased focus on the potential to design and implement preventive interventions. Meta-analyses of randomized controlled trials of individual-level behavioural interventions aimed at changing dietary and physical activity behaviour, mediated in most but not all populations by weight loss, have unequivocally established that these interventions are efficacious under the ideal circumstances that exist in clinical trials. Achieving comparable effectiveness in real-world settings has been much more challenging and there are as yet few examples of effective, scalable, and inexpensive interventions. Even in settings where individual-level interventions are affordable, such approaches need to be complemented by whole population approaches to prevention that implicitly acknowledge that the public health problem of diabetes cannot be dealt with by clinical approaches alone and needs a balanced approach of individual and societal-level action.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134293299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0042
R. Peeters, A. Boelen
Already a few hours after the onset of acute illness, marked changes in serum thyroid hormone levels occur. This is referred to as non-thyroidal illness (NTI) also known as the low T3 syndrome and the euthyroid sick syndrome. The most characteristic and persistent abnormality is a low serum T3. Nevertheless, patients usually have no clinical signs of thyroid dysfunction. A low T3 in euthyroid patients is also seen during caloric deprivation. Both in NTI and in fasting there is a negative energy balance in the majority of cases. Therefore, the low levels of T3 during NTI and starvation have been interpreted as an attempt to save energy expenditure, which does not need intervention. However, this remains controversial and has been a debate for many years.
{"title":"Non-Thyroidal Illness (NTI)","authors":"R. Peeters, A. Boelen","doi":"10.1093/med/9780198870197.003.0042","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0042","url":null,"abstract":"Already a few hours after the onset of acute illness, marked changes in serum thyroid hormone levels occur. This is referred to as non-thyroidal illness (NTI) also known as the low T3 syndrome and the euthyroid sick syndrome. The most characteristic and persistent abnormality is a low serum T3. Nevertheless, patients usually have no clinical signs of thyroid dysfunction. A low T3 in euthyroid patients is also seen during caloric deprivation. Both in NTI and in fasting there is a negative energy balance in the majority of cases. Therefore, the low levels of T3 during NTI and starvation have been interpreted as an attempt to save energy expenditure, which does not need intervention. However, this remains controversial and has been a debate for many years.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122041038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0075
H. Graf, G. Paz-Filho
Multinodular goitre (MNG) is a common thyroid disorder associated with more than one thyroid nodule. The clinical presentation varies from a completely asymptomatic goitre to a life-threatening disease with upper airway compression. Patients should have a careful clinical evaluation, thyroid function tests, ultrasonography, cross-sectional imaging, and fine-needle aspiration. The best therapeutic approach will depend on the size and location of the goitre, the presence of compressive symptoms and the clinical status. The recommended treatments include clinical observation, surgery, and administration of radioactive iodine (131I). Suppressive treatment with levothyroxine is discouraged due to its low efficacy compared with surgery or 131I and adverse effects. Total thyroidectomy is effective, but surgical complications may occur. The use of radioiodine after the elevation of thyroid-stimulating hormone (TSH) levels, either via the exogenous administration of recombinant human TSH or through the induction of transient primary subclinical hypothyroidism by antithyroid drugs, are relative novel alternative treatments.
{"title":"Management of Non-Toxic Multinodular Goitre","authors":"H. Graf, G. Paz-Filho","doi":"10.1093/med/9780198870197.003.0075","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0075","url":null,"abstract":"Multinodular goitre (MNG) is a common thyroid disorder associated with more than one thyroid nodule. The clinical presentation varies from a completely asymptomatic goitre to a life-threatening disease with upper airway compression. Patients should have a careful clinical evaluation, thyroid function tests, ultrasonography, cross-sectional imaging, and fine-needle aspiration. The best therapeutic approach will depend on the size and location of the goitre, the presence of compressive symptoms and the clinical status. The recommended treatments include clinical observation, surgery, and administration of radioactive iodine (131I). Suppressive treatment with levothyroxine is discouraged due to its low efficacy compared with surgery or 131I and adverse effects. Total thyroidectomy is effective, but surgical complications may occur. The use of radioiodine after the elevation of thyroid-stimulating hormone (TSH) levels, either via the exogenous administration of recombinant human TSH or through the induction of transient primary subclinical hypothyroidism by antithyroid drugs, are relative novel alternative treatments.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125727718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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