Toxic nodular goiter is an enlarged thyroid gland with multiple nodules that secrete thyroid hormone, causing hyperthyroidism. It is common in the elderly and can cause symptoms such as weight loss, anxiety, and high blood pressure. Diagnosis involves physical exams, thyroid scans, and blood tests. Treatment options include radioactive iodine, surgery, and medications. Complications can include heart failure and thyroid storm.
Toxic nodular goiter refers to an enlarged thyroid gland, or goiter, that contains multiple nodules that secrete thyroid hormone. Hypersecretion of thyroid hormone causes hyperthyroidism. Toxic nodular goiters commonly occur in the elderly and usually result from a long-present goiter. Symptoms of toxic nodular goiter can include weight loss, nervousness, anxiety, high blood pressure, increased appetite, increased sweating, fatigue, frequent bowel movements, muscle cramps, and menstrual irregularities.
Symptoms of toxic nodular goiter are similar to hyperthyroidism, except for bulging or bulging eyeballs which are a frequent manifestation of Grave’s hyperthyroidism. Risk factors for toxic nodular goiter include being over the age of 60 and being female. Toxic nodular goiters are rarely seen in children and their cause is unknown.
Diagnostic tests that may indicate toxic nodular goiter include a physical exam that may reveal multiple nodules and a rapid pulse or heart rate. A thyroid scan can be helpful in diagnosing toxic multinodular goiter, because radioactive iodine contrast material given before testing will typically show up in the nodules. Blood tests that may indicate toxic nodular goiter include serum thyroid-stimulating hormone levels and serum thyroid hormone levels.
Treatment of toxic nodular goiter may include radioactive iodine, surgery to remove the thyroid gland, or antithyroid medications. Beta-blockers, which are heart medications usually given to regulate the heart rate, can be given to control symptoms of hyperthyroidism such as palpitations and nervousness. Beta-blockers can be a transitory treatment, used only until the antithyroid drugs have regulated hormone levels.
The prognosis for toxic nodular goiter usually depends on other predisposing risk factors the patient may have. Since this condition is typically seen in the elderly, other medical problems can affect the prognosis. The elderly patient may be less tolerant of cardiac symptoms such as palpitations and may not be as responsive to treatment. Medications the patient is taking may interact or be contraindicated with thyroid medications.
Complications related to toxic nodular goiter can include congestive heart failure and atrial fibrillation. Atrial fibrillation is a heart condition in which the heart beats rapidly and irregularly. A serious complication of toxic nodular goiters is thyroid crisis or thyroid storm. Thyroid storm is an extreme worsening of hyperthyroidism symptoms that can occur due to an acute infection or stress. Thyroid storm may require hospitalization due to decreased levels of alertness, fever, abdominal pain, and irregular heartbeat.
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