Toxic nodular goiter
Toxic nodular goiter involves an enlarged thyroid gland that contains rounded growths called nodules. These nodules produce too much thyroid hormone.
Causes
Toxic nodular goiter grows from an existing simple goiter. It occurs most often in the elderly. Risk factors include being female and over 60 years old. This disorder is almost never seen in children.
Sometimes patients with toxic multinodular goiter will develop high thyroid levels for the first time after they receive a large amount of iodine through a vein (intravenously). The iodine may be used as contrast for a CT scan or heart catheterization.
Symptoms
Symptoms are those of an overactive thyroid gland (hyperthyroidism). However, the bulging eyeballs seen in Graves disease do not occur.
Symptoms include:
- Fatigue
- Frequent bowel movements
- Heat intolerance
- Increased appetite
- Increased sweating
- Irregular menstrual period (in women)
- Muscle cramps
- Nervousness
- Restlessness
- Weight loss
Exams and Tests
A physical examination will show one or many nodules in the thyroid. There may be a rapid heart rate.
Other tests that may be done:
- Serum thyroid hormone levels (T3, T4)
- Serum TSH (thyroid stimulating hormone)
- Thyroid scan
Treatment
Treatments include:
- Antithyroid drugs (propylthiouracil, methimazole)
- Radioactive iodine
- Surgery
Beta-blockers (propranolol) can control some of the symptoms of hyperthyroidism until thyroid hormone levels in the body are under control.
Outlook (Prognosis)
Because toxic nodular goiter is mainly a disease of the elderly, other chronic health problems may influence the outcome of this condition. An elderly person may be less able to tolerate the effect of hyperthyroidism on the heart.
Possible Complications
Heart complications:
- Congestive heart failure
- Irregular heartbeat (atrial fibrillation)
- Rapid heart rate
Other complications:
- Bone loss leading to osteoporosis
Thyroid crisis or storm is an acute worsening of hyperthyroidism symptoms. It may occur with infection or stress. Thyroid crisis may cause:
- Abdominal pain
- Decreased mental alertness
- Fever
People with this condition need to go to the hospital right away.
Complications of having a very large goiter may include difficulty breathing. This is due to pressure on the airway passage that lies behind the thyroid.
When to Contact a Medical Professional
Call your health care provider if you have symptoms of this disorder. 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.
Alternative Names
Toxic multinodular goiter; Plummer's disease
References
Ladenson P, Kim M. Thyroid. In: Goldman L and Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders; 2007:chap 244.
Davies TF, Larsen PR. Thyrotoxicosis. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 11.
Update Date: 6/4/2012
Updated by: Shehzad Topiwala, MD, Chief Consultant Endocrinologist, Premier Medical Associates, The Villages, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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