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Toxic nodular goiter

Toxic 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.

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. 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

 

Symptoms are the same as those of an overactive thyroid gland (hyperthyroidism). However, the bulging eyeballs seen in Graves disease do not occur.

Symptoms may include any of the following:

  • 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 uptake and scan
  • Thyroid ultrasound

 

Treatment

 

Treatments may include any of the following:

  • Antithyroid drugs
  • 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 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.

 

Prevention

 

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

 

 

References

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.

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    Thyroid gland

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    • Thyroid enlargement - scintiscan

      Thyroid enlargement - sc...

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      Thyroid gland

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          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.

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