Health Encyclopedia

Toxic nodular goiter

Definition

Toxic nodular goiter involves an enlarged thyroid gland that contains a small rounded mass or masses called nodules, which produce too much thyroid hormone.

Alternative Names

Toxic adenoma; Toxic multinodular goiter; Plummer's disease

Causes, incidence, and risk factors

Toxic nodular goiter arises from a long-standing simple goiter and occurs most often in the elderly. Symptoms are those of hyperthyroidism, but the protruding eyeballs seen in Graves' disease do not occur. Risk factors include being female and over 60 years old. This disorder is never seen in children.

Symptoms

weight loss
increased appetite
nervousness
restlessness
heat intolerance
increased sweating
fatigue
muscle cramps
frequent bowel movements
menstrual irregularities (in women)

Signs and tests

A physical examination reveals single or multiple nodules in the thyroid. There may be a rapid heart rate.

A thyroid scan shows elevated radioactive iodine uptake in the nodules.
Serum TSH (thyroid stimulating hormone) is decreased.
Serum thyroid hormone levels (T3, T4) are elevated.

Treatment

Radioactive iodine, surgery, or antithyroid drugs (propylthiouracil, methimazole) are the treatments used for toxic nodular goiter.

Beta-blockers, such as propranolol, can control some of the symptoms of hyperthyroidism until thyroid hormone levels in the body are under control.

Expectations (prognosis)

Since toxic nodular goiter is primarily 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

Cardiac (heart-related) complications include rapid heart rate, congestive heart failure, and atrial fibrillation (a rapid and irregular heart rhythm). Another complication of hyperthyroidism is bone loss leading to osteoporosis.

Thyroid crisis or storm is an acute worsening of the symptoms of hyperthyroidism, which may occur with infection or stress. Fever, decreased mental alertness, and abdominal pain may occur, and immediate hospitalization is necessary.

Complications of having a very large goiter may include difficulty breathing, due to pressure on the airway passage that lies behind the thyroid.

Calling your health care provider

Call your health care provider if symptoms of this disorder occur. 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.

Review Date:5/12/2006
Reviewed By:Robert Hurd, MD, Department of Biology, College of Arts and Sciences, Xavier University, Cincinnati, OH. Review provided by VeriMed Healthcare Network.

ADAM Quality A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The Agency for Health Care Administration (Agency) and this website do not claim the information on, or referred to by, this site is error free. This site may include links to websites of other government agencies or private groups. Our Agency and this website do not control such sites and are not responsible for their content. Reference to or links to any other group, product, service, or information does not mean our Agency or this website approves of that group, product, service, or information.

Additionally, while health information provided through this website may be a valuable resource for the public, it is not designed to offer medical advice. Talk with your doctor about medical care questions you may have.