Toxic nodular goiter

Thyroid enlargement - scintiscan

This image shows enlargement of the thyroid gland and extension down behind the breastbone (retrosternal space). The image, called a scintiscan, was generated using a radioactive isotope.

Also known as: Toxic multinodular goiter and Plummer's disease

Definition

Toxic nodular goiter involves an enlarged thyroid gland that contains a small rounded growth or growths called nodules. These nodules produce too much thyroid hormone.

Causes, incidence, and risk factors

Toxic nodular goiter arises 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 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 contrast for a CT scan or heart catheterization.

Symptoms

Symptoms are those of hyperthyroidism. However, the bulging eyeballs seen in Graves disease do not occur.

Symptoms include:

Signs and tests

A physical examination will show one or many nodules in the thyroid. There may be a rapid heart rate.

Other test results:

  • Serum thyroid hormone levels (T3, T4) are high.
  • Serum TSH (thyroid stimulating hormone) is low.
  • Thyroid scan shows that the nodules are taking up increased amounts of radioactive iodine.

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.

Expectations (prognosis)

Because toxic nodular goiter is mainly 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

Heart complications:

Other complications:

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

Immediate hospitalization is necessary.

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.

Calling your health care provider

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.

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.

See also:

  • Disease

    Hyperthyroidism

    Endocrine glands

    Hyperthyroidism is a condition in which the thyroid gland makes too much thyroid hormone. The condition is often referred to as an “overactive thyroid.”

  • Special Topic

    Acute

    Acute vs. chronic conditions

    Acute means sudden or severe. Acute symptoms appear, change, or worsen rapidly. It is the opposite of .

  • Symptoms

    Stress and anxiety

    Generalized anxiety disorder

    Stress can come from any situation or thought that makes you feel frustrated, angry, or anxious. What is stressful to one person is not necessarily stressful to another. Anxiety is a feeling of apprehension, nervousness, or fear. The source of this uneasiness is not always known or recognized, ...

  • Disease

    Goiter - simple

    Thyroid enlargement - scintiscan

    A goiter is an enlargement of the thyroid gland. It is not cancer. See also: Colloid nodule goiter

  • Disease

    Atrial fibrillation/flutter

    Heart, section through the middle

    Atrial fibrillation/flutter is a heart rhythm disorder (arrhythmia). It usually involves a rapid that is not regular.

  • Disease

    Heart failure

    Heart, section through the middle

    Heart failure, also called congestive heart failure, is a condition in which the heart can no longer pump enough blood to the rest of the body.

  • Disease

    Graves disease

    Endocrine glands

    Graves disease is an that leads to overactivity of the thyroid gland ().

Review date:
May 10, 2010
Reviewed by:
Ari S. Eckman, MD, Division of Endocrinology and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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