Toxic nodular goiterToxic multinodular goiter; Plummer disease
Toxic nodular goiter involves an enlarged thyroid gland. The gland contains areas that have increased in size and formed nodules. One or more of these nodules produce too much thyroid hormone.
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. Most patients who develop it have had a goiter with nodules for many years.
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) or by mouth. The iodine may be used as contrast for a CT scan or heart catheterization. Taking medicines that contain iodine, such as amiodarone, may also lead to the disorder.
Symptoms may include any of the following:
- Frequent bowel movements
- Heat intolerance
- Increased appetite
- Increased sweating
- Irregular menstrual period (in women)
- Muscle cramps
- Weight loss
Exams and Tests
Other tests that may be done:
- Serum thyroid hormone levels (T3, T4)
- Serum TSH (thyroid stimulating hormone)
- Thyroid uptake and scan
- Thyroid ultrasound
Treatments may include any of the following:
- Antithyroid drugs
- Radioactive iodine
Beta-blockers (propranolol) can control some of the symptoms of hyperthyroidism until thyroid hormone levels in the body are under control.
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.
- Bone loss leading to osteoporosis
- Abdominal pain
- Decreased mental alertness
People with this condition need to go to the hospital right away.
Complications of having a very large goiter may include difficulty breathing or swallowing. These complications are due to pressure on the airway passage (trachea) or esophagus, which 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.
To prevent toxic nodular goiter, treat hyperthyroidism and simple goiter as your health care provider recommends.
Mandel SJ, Larsen PR, Davies TF. Thyrotoxicosis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 12.
Chahal HS, Drake WM. Aging and the endocrine system. In: Fillit HM, Rockwood K, Woodhouse K, eds. Brocklehurst's Textbook of Geriatric Medicine and Gerontology. 7th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 20.
Review Date: 5/10/2014
Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.