Table Of Contents
Toxic Nodular Goiter
Toxic nodular goiter can be caused by a single nodule (toxic adenoma) or multiple nodules (**toxic multinodular goiter AKA Plummer’s disease)**They are the second most common cause of hyperthyroidism. Plummer’s disease is progressive and requires ablation or surgery to definitively treat the disease. Radioactive iodine ablation is less likely to be successful for Plummer’s disease than a toxic adenoma due to the large amounts of thyroid tissue needed to be ablated. Surgery is recommended for patients with large nodules and/or compressive symptoms.
They have an increased incidence in post-menopausal women.
- Signs and symptoms
- Hypermetabolic state (more subtle than grave’s disease)
- Weight loss
- Occasionally asymptomatic
- Physical exam
- Tachycardia
- Nodules(s) may or may not be palpable
- Investigations
- TSH level, T3/T4: Best initial diagnostic test
- Low TSH
- Elevated T3/T2
- Radioactive iodine uptake scan (RAIU)
- Increased uptake in nodules
- TSH level, T3/T4: Best initial diagnostic test
- Medical treatment
- Propranolol and Antithyroid drugs (PTU, Methimazole)
- Radioactive Iodine Therapy (definitive treatment)
- Surgical treatment (definitive treatment)
- Total thyroidectomy for Plummer’s disease
- Thyroid lobectomy for toxic adenoma
