MANIFESTAÇÕES ENDOCRINOLÓGICAS DO BÓCIO MULTINODULAR TÓXICO

Abstract

Introduction: Toxic multinodular goiter (TMG) is a condition characterized by abnormal growth of the thyroid gland, with the presence of multiple nodules that produce thyroid hormones autonomously. This excessive production of hormones leads to a clinical condition known as hyperthyroidism, which manifests itself through a series of symptoms such as tachycardia, weight loss, nervousness, and sweating. Understanding the endocrinological manifestations of TMG is essential for early diagnosis and adequate treatment of this condition, aiming to minimize complications and improve the quality of life of patients. Objective: This systematic literature review aimed to identify and summarize the main endocrinological manifestations of toxic multinodular goiter, with emphasis on the hormonal and metabolic alterations associated with the disease. Methodology: A systematic search was performed in the PubMed, SciELO and Web of Science databases, using the descriptors “toxic multinodular goiter”, “hyperthyroidism”, “clinical manifestations”, “hormonal alterations” and “complications”. The selection of studies included original articles published in the last 10 years, in Portuguese or English, that addressed the endocrinological manifestations of BMT in adults. The following inclusion criteria were applied: observational studies, randomized clinical trials and systematic reviews; patients with a confirmed diagnosis of BMT; and articles that evaluated the endocrinological manifestations of the disease. The exclusion criteria were: studies in animals, narrative reviews and articles that did not address the endocrinological manifestations of BMT. Study selection and data extraction were performed by two independent reviewers, using the PRISMA checklist. Results: The review identified a significant number of studies that addressed the endocrinological manifestations of BMT. The results demonstrated that hyperthyroidism is the main clinical manifestation of the disease, characterized by elevated levels of thyroid hormones (free T3 and T4) and suppression of thyrotropic hormone (TSH). In addition, several other endocrinological alterations associated with BMT were identified, such as osteoporosis, dyslipidemia and insulin resistance. The severity of these alterations varies according to the duration and intensity of hyperthyroidism. Conclusion: Toxic multinodular goiter is a complex condition that manifests itself by a series of endocrinological alterations, in addition to hyperthyroidism. Understanding these manifestations is essential for early diagnosis and adequate treatment of patients with BMT, aiming to prevent complications and improve quality of life. Treatment of BMT may include the use of antithyroid drugs, radioactive iodine or surgery, and the choice of the most appropriate therapy is individualized for each patient.