Radioiodine in Diagnosis and Therapy of Hyperthyroidism: Hyperthyroidism Caused by Hyperfunctioning Thyroid Adenoma

The occurrence of hyperthyroidism particularly in the older patient with a nodular goiter has resulted in the publication of numerous papers on the radioiodine treatment of "toxic nodular goiter." The term "toxic nodular goiter" as used by the authors of these published reports recently reviewed by Eller and associates 1 implies that the hyperthyroidism is caused by a hyperfunctioning nodule or nodules in the goiter. In reality however, careful perusal of many of these reports reveals that a variable number of patients with Graves' disease have been included in these series. In such patients it is the internodular thyroid tissue which undergoes hyperplasia producing the hyperthyroidism, while the nodules are actually non functioning. Clinically, this is further substantiated by the inclusion of patients with exophthalmos 1-4 which is specific for Graves' disease. Also, the occurrence of hypothyroidism which has been reported averaging 7%-8% of the patients in 14 of the