Toxic multinodular goiter

Alternative names
Toxic adenoma; Toxic nodular goiter; Plummer’s disease

Definition
Toxic nodular goiter involves an enlarged thyroid gland that contains a small rounded mass or masses called nodules, which produce too much thyroid hormone.

Causes, incidence, and risk factors

Toxic nodular goiter arises from a long-standing simple goiter and occurs most often in the elderly. Symptoms are those of hyperthyroidism, but the protruding eyeballs seen in Graves’ disease do not occur. Risk factors include being female and over 60 years old. This disorder is never seen in children.

Symptoms

     
  • Weight Loss  
  • increased appetite  
  • nervousness  
  • restlessness  
  • heat intolerance  
  • increased sweating  
  • fatigue  
  • muscle cramps  
  • frequent bowel movements  
  • menstrual irregularities (in women)

Signs and tests

A physical examination reveals single or multiple nodules in the thyroid. There may be a rapid heart rate.

     
  • A thyroid scan shows elevated radioactive iodine uptake in the nodules.  
  • Serum TSH (thyroid stimulating hormone) is decreased.  
  • Serum thyroid hormone levels (T3, T4) are elevated.

Treatment

Radioactive iodine, surgery, or antithyroid drugs (propylthiouracil, methimazole) are the treatments used for toxic nodular goiter.

Beta-blockers, such as propranolol, can control some of the symptoms of hyperthyroidism until thyroid hormone levels in the body are under control.

Expectations (prognosis)
Since toxic nodular goiter is primarily a disease of the elderly, other chronic health problems may influence the outcome of this condition. The elderly person may be less able to tolerate the effect of hyperthyroidism on the heart.

Complications

Cardiac complications include rapid heart rate, congestive heart failure, and Atrial Fibrillation (a rapid and irregular heart rhythm). Another complication of hyperthyroidism is bone loss leading to Osteoporosis.

Thyroid crisis or storm is an acute worsening of the symptoms of hyperthyroidism, which may occur with infection or stress. Fever, decreased mental alertness, and Abdominal pain may occur, and immediate hospitalization is necessary.

Calling your health care provider

Call your health care provider if symptoms of this disorder occur. Follow the health care provider’s recommendations for follow-up visits.

Prevention

To prevent toxic nodular goiter, treat hyperthyroidism and simple goiter as your health care provider recommends.

Johns Hopkins patient information

Last revised: December 7, 2012
by Mamikon Bozoyan, M.D.

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