Patient Education - Endocrine Encyclopedia
Endocrine Surgery Encyclopedia
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.
Support Groups:
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.
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