To the Editor.—
In 1913, Plummer differentiated diffuse toxic goiter from toxic autonomous nodular goiter on the basis of observation on 2,000 patients who underwent operations.1 The autonomous nodular goiter presents a special diagnostic problem in its toxic and pretoxic stages, because of the existence in it of inactive thyroid tissue that gives a "cold" appearance in the scintigram. The nodules are variable in size, most of them are larger than the surrounding suppressed normal tissue, and in cross section represent a group of variable-sized, functioning follicles.2 Functional capacity of these autonomous nodules is limited in comparison to diffuse toxic disease, toxicity is only produced after a dimension of three to four cm is reached.2,3A new area of suppressed function was noted by our group in the autonomous nodular goiter; it occurs usually in a central position in the autonomous nodule (Fig 1 and 2). This
ASHKAR FS, Smoak WM. "Owl Eye" Sign of Benign Autonomous Thyroid Nodule. JAMA. 1970;214(8):1563. doi:10.1001/jama.1970.03180080143030
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