Toxic multinodular goiter (patient information)
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Assosciate Editor(s)-In-Chief: Prashanth Saddala M.B.B.S
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Overview
Toxic nodular goiter involves an enlarged thyroid gland that contains rounded growths called nodules. These nodules produce too much thyroid hormone.
What are the symptoms of Toxic multinodular goiter?
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
What causes Toxic multinodular goiter?
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.
Who is at highest risk?
Common risk factors in the development of multinodular goiter include female sex, age over 50 years, areas with decreased iodine intake, iodine supplementation, natural goitrogens, vitamin A deficiency, iron deficiency and selenium deficiency.
Diagnosis
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)
When to seek urgent medical care?
Call your health care provider if you have symptoms of this disorder. Follow the health care provider's recommendations for follow-up visits
Treatment options
Treatments include:
Beta-blockers (propranolol) can control some of the symptoms of hyperthyroidism until thyroid hormone levels in the body are under control
Where to find medical care for Toxic multinodular goiter?
Prevention of Toxic multinodular goiter
To prevent toxic nodular goiter, treat hyperthyroidism and simple goiter as your health care provider recommends.
What to expect (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.