Thyroid nodules that function in the presence of a suppressed blood TSH level are referred to as autonomous or hot nodules. Autonomous function and autonomous growth may or may not be related. Thus, cold nodules and hot nodules within a nodular goiter may have exactly the same growth potential and may respond or be refractory to TSH-suppressive T4 treatment.21 Some thyroid follicular cells take up and organify iodine in the absence of TSH, causing hot or autonomous nodules. As previously mentioned, these nodules usually have either TSHR mutations or, less commonly, gsp mutations. When these nodules reach a certain size and secrete increased amounts of thyroid hormone, the patient develops subclinical and then overt hyperthyroidism. This may occur either spontaneously or after exposure to an excessive amount of iodine (Jodbasedow hyperthyroidism).27

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