Toxic nodular goiter
Toxic multinodular goiter; Plummer disease; Thyrotoxicosis - nodular goiter; Overactive thyroid - toxic nodular goiter; Hyperthyroidism - toxic nodular goiter; Toxic multinodular goiter; MNGToxic 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 starts from an existing simple goiter. It occurs most often in older adults. Risk factors include being female and over 55 years old. This disorder is rare in children. Most people who develop it have had a goiter with nodules for many years. Sometimes the thyroid gland is only slightly enlarged, and the goiter was not already diagnosed.
Simple goiter
A simple goiter is an enlargement of the thyroid gland. It is usually not a tumor or cancer.
Read Article Now Book Mark ArticleSometimes, people with toxic multinodular goiter will develop high thyroid hormone levels for the first time after:
- Taking iodine through a vein (intravenously) or by mouth. The iodine may be used as contrast for a CT scan or heart catheterization (most common)
Intravenously
Intravenous means "within a vein. " Most often it refers to giving medicines or fluids through a needle or tube inserted into a vein. This allows th...
Read Article Now Book Mark ArticleCT scan
A computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body. Related tests include:Abdomin...
Read Article Now Book Mark ArticleHeart catheterization
Cardiac catheterization involves passing a thin flexible tube (catheter) into the right or left side of the heart. The catheter is most often insert...
Read Article Now Book Mark Article - Taking medicines that contain iodine, such as amiodarone
- Moving from a country with iodine deficiency to a country with a lot of iodine in the diet
Symptoms
Symptoms may include any of the following:
- Fatigue
Fatigue
Fatigue is a feeling of weariness, tiredness, or lack of energy.
Read Article Now Book Mark Article - Frequent bowel movements
- Heat intolerance
Heat intolerance
Heat intolerance is a feeling of being overheated when the temperature around you rises. It can often cause heavy sweating. Heat intolerance usually...
Read Article Now Book Mark Article - Increased appetite
- Increased sweating
- Irregular menstrual period (in women)
- Muscle cramps
Muscle cramps
Muscle cramps are when a muscle gets tight (contracts) without you trying to tighten it, and it does not relax. Cramps may involve all or part of on...
Read Article Now Book Mark Article - Nervousness
- Restlessness
Restlessness
Agitation is an unpleasant state of extreme arousal. An agitated person may feel stirred up, excited, tense, confused, or irritable.
Read Article Now Book Mark Article - Weight loss
Older adults may have symptoms that are less specific. These may include:
- Weakness and fatigue
- Palpitations and chest pain or pressure
Palpitations
Palpitations are feelings or sensations that your heart is pounding or racing. They can be felt in your chest, throat, or neck. You may:Have an unpl...
Read Article Now Book Mark Article - Changes in memory and mood
Toxic nodular goiter does not cause the bulging eyes that can occur with Graves disease. Graves disease is an autoimmune disorder that leads to an overactive thyroid gland (hyperthyroidism).
Graves disease
Graves disease is an autoimmune disorder that leads to an overactive thyroid gland (hyperthyroidism). An autoimmune disorder is a condition that occ...
Read Article Now Book Mark ArticleHyperthyroidism
Hyperthyroidism is a condition in which the thyroid gland makes too much thyroid hormone. The condition is often called overactive thyroid.
Read Article Now Book Mark ArticleExams and Tests
A physical exam may show one or many nodules in the thyroid. The thyroid is often enlarged. There may be a rapid heart rate or shaking hands (tremor).
Physical exam
During a physical examination, a health care provider checks your body to determine if you do or do not have a physical problem. A physical examinati...
Read Article Now Book Mark ArticleRapid heart rate
A bounding pulse is a strong throbbing felt over one of the arteries in the body. It is due to a forceful heartbeat.
Read Article Now Book Mark ArticleTremor
A tremor is a type of shaking movement. A tremor is most often noticed in the hands and arms. It may affect any body part, including the head, tong...
Read Article Now Book Mark ArticleOther tests that may be done include:
- Serum thyroid hormone levels (T3, T4)
T3
Triiodothyronine (T3) is a thyroid hormone. It plays an important role in the body's control of metabolism (the many processes that control the rate...
Read Article Now Book Mark ArticleT4
T4 (thyroxine) is the main hormone produced by the thyroid gland. A laboratory test can be done to measure the amount of free T4 in your blood. Fre...
Read Article Now Book Mark Article - Serum TSH (thyroid stimulating hormone)
Serum TSH
A TSH test measures the amount of thyroid stimulating hormone (TSH) in your blood. TSH is produced by the pituitary gland. It prompts the thyroid g...
Read Article Now Book Mark Article - Thyroid uptake and scan
Thyroid uptake
Radioactive iodine uptake (RAIU) tests thyroid function. It measures how much radioactive iodine is taken up by your thyroid gland in a certain time...
Read Article Now Book Mark ArticleScan
A thyroid scan uses a radioactive iodine tracer to examine the structure and function of the thyroid gland. This test is often done together with a ...
Read Article Now Book Mark Article - Thyroid ultrasound
Thyroid ultrasound
A thyroid ultrasound is an imaging method to see the thyroid, a gland in the neck that regulates metabolism (the many processes that control the rate...
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Treatment
Beta-blockers can control some of the symptoms of hyperthyroidism until thyroid hormone levels in the body are under control.
Certain medicines can block or change how the thyroid gland uses iodine. These may be used to control the overactive thyroid gland in any of the following cases:
- Before surgery or radioiodine therapy occurs
- As a long term treatment
Radioiodine therapy may be used. Radioactive iodine is given by mouth. It concentrates in the overactive thyroid tissue and causes damage. In rare cases, thyroid replacement is needed afterward.
Surgery to remove the thyroid may be done when:
- A very large goiter or a goiter is causing symptoms by making it hard to breathe or swallow
- Thyroid cancer is present
- Rapid treatment is needed
Outlook (Prognosis)
Toxic nodular goiter is mainly a disease of older adults. So, other chronic health problems may affect the outcome of this condition. An older adult may be less able to tolerate the effect of the disease on the heart. However, the condition is often treatable with medicines.
Chronic
Chronic refers to something that continues over an extended period of time. A chronic condition is usually long-lasting and does not easily or quick...
Read Article Now Book Mark ArticlePossible Complications
Heart complications:
- Heart failure
Heart failure
Heart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. This causes symptom...
Read Article Now Book Mark Article - Irregular heartbeat (atrial fibrillation)
Atrial fibrillation
Atrial fibrillation (Afib) and atrial flutter are common types of abnormal heart rhythms (arrhythmias) which affect the upper chambers (atria) of the...
Read Article Now Book Mark Article - Rapid heart rate
Other complications:
-
Bone loss leading to osteoporosis
Osteoporosis
Osteoporosis is a disease in which bones become fragile and more likely to break (fracture).
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Thyroid crisis or storm is a sudden 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. This is due to pressure on the airway passage (trachea) or esophagus, which lies behind the thyroid.
When to Contact a Medical Professional
Contact your health care provider if you have symptoms of this disorder listed above. Follow your provider's instructions for follow-up visits.
Prevention
To prevent toxic nodular goiter, treat hyperthyroidism and simple goiter as your provider suggests.
References
Filetti S, Tuttle RM, Leboulleux S, Alexander EK. Nontoxic diffuse goiter, nodular thyroid disorders, and thyroid malignancies. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 14.
Paschke R, Eszlinger M, Kopp P. Euthyroid and hyperthyroid nodules and goiter. In: Robertson RP, ed. DeGroot's Endocrinology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 77.
Pearce EN, Hollenberg AN. Thyroid. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 207.
Suh I, Sosa JA. Thyroid. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 37.
Thyroid enlargement - scintiscan - illustration
This image shows the enlargement of the thyroid gland and extension down behind the breastbone (retrosternal space). The image, called a scintiscan, was generated using a radioactive isotope.
Thyroid enlargement - scintiscan
illustration
Thyroid gland - illustration
The thyroid gland, a part of the endocrine (hormone) system, plays a major role in regulating the body's metabolism.
Thyroid gland
illustration
Thyroid enlargement - scintiscan - illustration
This image shows the enlargement of the thyroid gland and extension down behind the breastbone (retrosternal space). The image, called a scintiscan, was generated using a radioactive isotope.
Thyroid enlargement - scintiscan
illustration
Thyroid gland - illustration
The thyroid gland, a part of the endocrine (hormone) system, plays a major role in regulating the body's metabolism.
Thyroid gland
illustration
Review Date: 2/28/2024
Reviewed By: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.