WordNet

of or relating to or caused by a toxin or poison; "suffering from exposure to toxic substances"
abnormally enlarged thyroid gland; can result from underproduction or overproduction of hormone or from a deficiency of iodine in the diet (同)goitre, struma, thyromegaly

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毒性の,有毒な / 毒による

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/01/11 13:48:58」(JST)

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Toxic multinodular goiter (also known as toxic nodular goiter, toxic nodular struma, or Plummer's disease) is a multinodular goiter associated with a hyperthyroidism.

It is a common cause of hyperthyroidism^[1]^[2] in which there is excess production of thyroid hormones from functionally autonomous thyroid nodules, which do not require stimulation from thyroid stimulating hormone (TSH).^[3]

It is the second most common cause of hyperthyroidism (after Graves' disease) in the developed world. In countries where the population is iodine-deficient i.e. the developing world, iodine deficiency is the most common cause of hypothyroidism. (Decreased iodine leads to decreased thyroid hormone.) However, iodine deficiency can cause goitre (thyroid enlargement); within a goitre, nodules can develop. Risk factors for toxic multinodular goiter include individuals over 60 years of age and being female.^[4]

Signs and symptoms

Symptoms of toxic multinodular goitre are similar to that of hyperthyroidism, including:^[4]

heat intolerance
muscle weakness/wasting
hyperactivity
fatigue
tremor
irritability
weight loss
osteoporosis
increased appetite
non-painful goitre (swelling of the thyroid gland)
tachycardia (high heart rate - above 100 beats per minute at rest in adults)

Causes

Sequence of events:^[5]

Iodine deficiency leading to decreased T4 production.
Induction of thyroid cell hyperplasia due to low levels of T4. This accounts for the multinodular goitre appearance.
Increased replication predisposes to a risk of mutation in the TSH receptor.
If the mutated TSH receptor is constitutively active, it would then become 'toxic' and produces excess T3/T4 leading to hyperthyroidism.

Treatments

Toxic multinodular goiter can be treated with antithyroid medications such as propylthiouracil or methimazole, radioactive iodine, or with surgery.^[4]

Another treatment option is injection of ethanol into the nodules.^[6]

Related eponym

Plummer's disease is named after the American physician Henry Stanley Plummer but refers to a single toxic nodule (adenoma) which may present with the background of a suppressed multinodular goitre.^[7]

References

^ de Rooij, A; Vandenbroucke, JP; Smit, JW; Stokkel, MP; Dekkers, OM (2009). "Clinical outcomes after estimated versus calculated activity of radioiodine for the treatment of hyperthyroidism: systematic review and meta-analysis.". European Journal of Endocrinology (Bioscientifica) 161 (5): 771–777. doi:10.1530/EJE-09-0286. PMID 19671708.
^ Krohn, K; Fuhrer, D; Bayer, Y; Eszlinger, M; Brauer, V; Neumann, S; Paschke, R (2005). "Molecular pathogenesis of euthyroid and toxic multinodular goiter.". Endocrine reviews 26 (4): 504–524. doi:10.1210/er.2004-0005. PMID 15615818.
^ Reid, JR; Wheeler, SF (2005). "Hyperthyroidism: diagnosis and treatment.". American family physician 72 (4): 623–630. PMID 16127951.
^ ^a ^b ^c A.D.A.M. Medical Encyclopedia (2012). "Toxic nodular goiter". U.S. National Library of Medicine. Retrieved 30 January 2013.
^ Toxic Nodular Goiter at eMedicine
^ al.], senior editors, J. Larry Jameson, Leslie J. De Groot ; section editors, David de Kretser ... [et (2010). Endocrinology : adult and pediatric (6th ed.). Philadelphia: Saunders/Elsevier. p. Chapter 82. ISBN 9781416055839.
^ Plummer's disease eponymously named after Henry Stanley Plummer at Who Named It?

External links

UpToDate Contents

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1. 中毒性腺腫および中毒性多結節性甲状腺腫の治療 treatment of toxic adenoma and toxic multinodular goiter
2. 甲状腺機能亢進症の原因となる疾患 disorders that cause hyperthyroidism
3. 甲状腺機能亢進症に対する外科的マネージメント surgical management of hyperthyroidism
4. 甲状腺機能亢進症の診断 diagnosis of hyperthyroidism
5. 放射性ヨウ素による甲状腺機能亢進症の治療 radioiodine in the treatment of hyperthyroidism

English Journal

Cytometric evaluation of intracellular IFN-gamma AND IL-4 levels in thyroid follicular cells from patients with autoimmune thyroid diseases.

Bossowski A, Harasymczuk J, Moniuszko A, Bossowska A, Hilczer M, Ratomski K.AbstractABSTRACT:
Thyroid research.Thyroid Res.2011 Sep 23;4(1):13. [Epub ahead of print]
ABSTRACT:BACKGROUND: In recent few years is underlined that altered balance of pro- and anti-inflammatory cytokines play an important role in the pathogenesis of AITD. The aim of this study was to estimate intracellular INF-gamma and IL-4 levels in thyroid-infiltrating lymphocytes and thyr
PMID 21943174

Chorea Associated with Thyrotoxicosis Due to Toxic Multinodular Goiter.

Masannat Y, Gandhy R, Olajide O, Kheetan R, Yaqub A.Source1 Department of Medicine, Marshall University , Huntington, West Virginia.
Thyroid : official journal of the American Thyroid Association.Thyroid.2011 Sep 21. [Epub ahead of print]
PMID 21936672

Japanese Journal

Two rare TSH receptor amino acid substitutions in toxic thyroid adenomas

Endocrine Journal 59(1), 13-19, 2012
NAID 130004443752

Toxic Multinodular Goiter with Low Radioactive Iodine Uptake

Internal Medicine 50(16), 1709-1714, 2011
NAID 130000969373

Short term effects of levothyroxine treatment in thyroid multinodular disease

Endocrine Journal 57(9), 803-809, 2010
NAID 130004443649

Related Pictures

★リンクテーブル★

リンク元	「甲状腺」「中毒性多結節性甲状腺腫」
拡張検索	「nontoxic multinodular goiter」
関連記事	「toxic」

「甲状腺」

Toxic multinodular goiter
Classification and external resources
Specialty	Endocrinology
ICD-10	E05.2
ICD-9-CM	242.3
DiseasesDB	13184
MedlinePlus	000317
eMedicine	med/920

　　[★]

英: thyroid gland
ラ: glandula thyroidea
関: 甲状腺ホルモン、副甲状腺(上皮小体); 喉頭

図：N.24(全面の筋),25(全面の筋),70(血管),71(血管)

解剖学

部位

胸骨舌骨筋と胸骨甲状筋の裏で、輪状軟骨の下部に位置する。
C5-T1椎体の高さ

性状

成人の正常重量15-25g、女性の方が少し重い。妊娠中や性周期で重量が変化する。分泌期初期（early secretary phase排卵後2-5日目）には50%も重量が増加する。

大きさ

よくわかる甲状腺疾患のすべて　永井書店 (2004/01)　ISBN 481591673X

単位はmm？

	n	峡部	横断厚	横径	縦経(右)	縦経(左)
男性	34	1.8±0.6	18±3.0	48±4.8	49±3.7	49±3.8
女性	16	1.3±0.8	16±2.2	46±3.6	45±6.0	46±3.0

血管

動脈

静脈

神経

声帯を支配する神経が甲状腺の裏側を通過 N.71

画像

超音波検査

(高エコー)筋肉＞甲状腺＞気道(低エコー)　　←　要確認

びまん性腫大、等エコー～低エコー：グレーブス病
低エコー・高エコーの混在：甲状腺癌
不均一な粗い低エコー：橋本病
炎症部位は低エコーとなる：亜急性甲状腺炎

組織学

濾胞上皮細胞 follicular cell

甲状腺ホルモンを産生、分泌。

C細胞 C cell

成人甲状腺全体の0.1%を占める
カルシトニン産生細胞、HEでは判別困難。
銀染色(Glimerius)、免疫組織化学（chromogranin A、synaprophysin, carcitoninなど）により明らかとなる。
電顕では、electron dense な顆粒を有する（神経内分泌顆粒）。

機能

濾胞上皮細胞で甲状腺濾胞ホルモン(甲状腺ホルモン)を産生・分泌。甲状腺刺激ホルモンが刺激となる。
傍濾胞細胞でカルシトニンを産生・分泌

発生

甲状腺は舌盲孔で咽頭底の上皮性増殖として出現
舌盲孔で陥入し、咽頭腸の前を2葉に分かれて下降する。
甲状腺が陥入してできた管を甲状舌管という。
発生学的由来：咽頭底の上皮性上皮、内胚葉

神経支配

上頚部交感神経節、中頚部交感神経節。交感神経神経線維は濾胞近傍に終末し、分泌に影響を及ぼす。

臨床関連

診察所見と疾患

びまん性に腫大しており、柔らかい：グレーブス病、単純性甲状腺腫
硬い：橋本病
圧痛あり：亜急性甲状腺炎、急性化膿性甲状腺炎、橋本病の急性増悪、一部の甲状腺嚢胞

非腫瘍性疾患

1. 遺伝疾患、発達傷害

a) 無形成 Agenesis
b) 低形成 Hypoplasia
c) 異所性甲状腺：異残物

2. 甲状舌管嚢胞 (thyroglossal duct cyst)：異残物
3. 薬剤の影響：

mynocyclineによるblack thyroid：消耗性色素リポフスチンと他の物質（lipid-drug complexによりlysosomeに色素が沈着する）。

4. 感染

a) 急性甲状腺炎
b) 亜急性甲状腺炎

5. 自己免疫性甲状腺疾患

a) 橋本病
b) Basedow病 (Graves病）
c) 限局性リンパ球性甲状腺炎 focal lymphocytic thyroiditis
d) 浸潤性線維性甲状腺炎 invasive fibrous thyroiditis, Riedel's thyroiditis

6. 甲状腺腫 goiter

a) simple and multinodular nontoxic goiter
b) ホルモン合成傷害性甲状腺腫 dyshormonogenetic goiter
c) toxic multinodular goiter (Plummer病）
d) amyloid goiter

7. C細胞過形成 C-cell hyperplasia

腫瘍性疾患 (甲状腺腫瘍)

1. 良性腫瘍

a) 濾胞腺腫 follicular adenoma

2. 悪性腫瘍（甲状腺癌）悪性腫瘍中の頻度

a) 乳頭癌 papillary carcinoma　88%
b) 濾胞癌 follicular carcinoma 4.2%　甲状腺濾胞癌 thyroid follicular carcinoma
c) 低分化癌 poorly differentiated carcinoma
d) 未分化癌 undifferentiated carcinoma 1.5%
e) 髄様癌(C細胞癌) medullary carcinoma, C-cell carcinoma 1.4%
f) 悪性リンパ腫 malignant lymphoma 3.5%

Henry Gray (1825-1861). Anatomy of the Human Body. 1918.
Henry Gray (1825-1861). Anatomy of the Human Body. 1918.
Henry Gray (1825-1861). Anatomy of the Human Body. 1918.

分類

七條分類

「中毒性多結節性甲状腺腫」

　　[★]

英: toxic multinodular goiter
関: 機能性甲状腺結節

[show details]

中毒性多結節性甲状腺腫 : 約 5,630 件
中毒性多発性甲状腺腫 : nothing

「nontoxic multinodular goiter」

　　[★]

非中毒性多結節性甲状腺腫、腺腫様甲状腺腫

「toxic」

　　[★]

adj.

有毒な、毒性のある、中毒性の

関: intoxicated、poisonous、toxicity、venomous、virulence、virulent

[Europe-1] Rooij, A; Vandenbroucke, JP; Smit, JW; Stokkel, MP; Dekkers, OM (2009). "Clinical outcomes after estimated versus calculated activity of radioiodine for the treatment of hyperthyroidism: systematic review and meta-analysis.". European Journal of Endocrinology (Bioscientifica) 161 (5): 771–777. doi:10.1530/EJE-09-0286. PMID 19671708.

[endocrine-2] Krohn, K; Fuhrer, D; Bayer, Y; Eszlinger, M; Brauer, V; Neumann, S; Paschke, R (2005). "Molecular pathogenesis of euthyroid and toxic multinodular goiter.". Endocrine reviews 26 (4): 504–524. doi:10.1210/er.2004-0005. PMID 15615818.

[family-3] Reid, JR; Wheeler, SF (2005). "Hyperthyroidism: diagnosis and treatment.". American family physician 72 (4): 623–630. PMID 16127951.

[Adam-4] A.D.A.M. Medical Encyclopedia (2012). "Toxic nodular goiter". U.S. National Library of Medicine. Retrieved 30 January 2013.

[5] Toxic Nodular Goiter at eMedicine

[6] .], senior editors, J. Larry Jameson, Leslie J. De Groot ; section editors, David de Kretser ... [et (2010). Endocrinology : adult and pediatric (6th ed.). Philadelphia: Saunders/Elsevier. p. Chapter 82. ISBN 9781416055839.

[7] Plummer's disease eponymously named after Henry Stanley Plummer at Who Named It?

匿名

検索

案内

toxic multinodular goiter