BACK TOTOP Browse A-ZSearchBrowse A-ZABCDEFGHIJKLMNOPQRSTUVWXYZ0-9 E-mail FormEmail ResultsName:Email address:Recipients Name:Recipients address:Message: Print-FriendlyBookmarksbookmarks-menuToxic nodular goiterToxic multinodular goiter; Plummer disease; Thyrotoxicosis - nodular goiter; Overactive thyroid - toxic nodular goiter; Hyperthyroidism - toxic nodular goiter; Toxic multinodular goiter; MNGToxic nodular goiter involves an enlarged thyroid gland. The gland contains areas that have increased in size and formed nodules. One or more of these nodules produce too much thyroid hormone. Causes Toxic nodular goiter starts from an existing simple goiter. It occurs most often in older adults. Risk factors include being female and over 55 years old. This disorder is rare in children. Most people who develop it have had a goiter with nodules for many years. Sometimes the thyroid gland is only slightly enlarged, and the goiter was not already diagnosed.Simple goiterA simple goiter is an enlargement of the thyroid gland. It is usually not a tumor or cancer.ImageRead Article Now Book Mark Article Sometimes, people with toxic multinodular goiter will develop high thyroid levels for the first time. This mostly occurs after they take in a large amount of iodine through a vein (intravenously) or by mouth. The iodine may be used as contrast for a CT scan or heart catheterization. Taking medicines that contain iodine, such as amiodarone, may also lead to the disorder. Moving from a country with iodine deficiency to a country with a lot of iodine in the diet can also turn a simple goiter into a toxic goiter.CT scanA computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body. Related tests include:Abdomin...ImageRead Article Now Book Mark Article Heart catheterizationCardiac catheterization involves passing a thin flexible tube (catheter) into the right or left side of the heart. The catheter is most often insert...ImageRead Article Now Book Mark Article Symptoms Symptoms may include any of the following:Fatigue FatigueFatigue is a feeling of weariness, tiredness, or lack of energy.Read Article Now Book Mark Article Frequent bowel movements Heat intolerance Heat intoleranceHeat intolerance is a feeling of being overheated when the temperature around you rises. It can often cause heavy sweating. Heat intolerance usually...Read Article Now Book Mark Article Increased appetite Increased sweating Irregular menstrual period (in women) Muscle cramps Muscle crampsMuscle cramps are when a muscle gets tight (contracts) without you trying to tighten it, and it does not relax. Cramps may involve all or part of on...ImageRead Article Now Book Mark Article Nervousness Restlessness RestlessnessAgitation is an unpleasant state of extreme arousal. An agitated person may feel stirred up, excited, tense, confused, or irritable.Read Article Now Book Mark Article Weight lossOlder adults may have symptoms that are less specific. These may include:Weakness and fatigue Palpitations and chest pain or pressure Changes in memory and moodToxic nodular goiter does not cause the bulging eyes that can occur with Graves disease. Graves disease is an autoimmune disorder that leads to an overactive thyroid gland (hyperthyroidism). Exams and Tests A physical exam may show one or many nodules in the thyroid. The thyroid is often enlarged. There may be a rapid heart rate or a tremor.Physical examDuring a physical examination, a health care provider studies your body to determine if you do or do not have a physical problem. A physical examinat...Read Article Now Book Mark Article Rapid heart rateA bounding pulse is a strong throbbing felt over one of the arteries in the body. It is due to a forceful heartbeat.ImageRead Article Now Book Mark Article Other tests that may be done include:Serum thyroid hormone levels (T3, T4) T3Triiodothyronine (T3) is a thyroid hormone. It plays an important role in the body's control of metabolism (the many processes that control the rate...ImageRead Article Now Book Mark Article T4T4 (thyroxine) is the main hormone produced by the thyroid gland. A laboratory test can be done to measure the amount of free T4 in your blood. Fre...ImageRead Article Now Book Mark Article Serum TSH (thyroid stimulating hormone) Serum TSHA TSH test measures the amount of thyroid stimulating hormone (TSH) in your blood. TSH is produced by the pituitary gland. It prompts the thyroid g...ImageRead Article Now Book Mark Article Thyroid uptake and scan or radioactive iodine uptake Thyroid uptake and scanA thyroid scan uses a radioactive iodine tracer to examine the structure and function of the thyroid gland. This test is often done together with a ...ImageRead Article Now Book Mark Article Radioactive iodine uptakeRadioactive iodine uptake (RAIU) tests thyroid function. It measures how much radioactive iodine is taken up by your thyroid gland in a certain time...ImageRead Article Now Book Mark Article Thyroid ultrasoundThyroid ultrasoundA thyroid ultrasound is an imaging method to see the thyroid, a gland in the neck that regulates metabolism (the many processes that control the rate...ImageRead Article Now Book Mark Article Treatment Beta-blockers can control some of the symptoms of hyperthyroidism until thyroid hormone levels in the body are under control.Certain medicines can block or change how the thyroid gland uses iodine. These may be used to control the overactive thyroid gland in any of the following cases:Before surgery or radioiodine therapy occurs As a long term treatmentRadioiodine therapy may be used. Radioactive iodine is given by mouth. It then concentrates in the overactive thyroid tissue and causes damage. In rare cases, thyroid replacement is needed afterward.Surgery to remove the thyroid may be done when:Very large goiter or a goiter is causing symptoms by making it hard to breathe or swallow Thyroid cancer is present Rapid treatment is needed Outlook (Prognosis) Toxic nodular goiter is mainly a disease of older adults. So, other chronic health problems may affect the outcome of this condition. An older adult may be less able to tolerate the effect of the disease on the heart. However, the condition is often treatable with medicines.ChronicChronic refers to something that continues over an extended period of time. A chronic condition is usually long-lasting and does not easily or quick...ImageRead Article Now Book Mark Article Possible Complications Heart complications:Heart failure Heart failureHeart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. This causes symptom...ImageRead Article Now Book Mark Article Irregular heartbeat (atrial fibrillation) Atrial fibrillationAtrial fibrillation or flutter is a common type of abnormal heartbeat. The heart rhythm is fast and most often irregular.ImageRead Article Now Book Mark Article Rapid heart rate Other complications: Bone loss leading to osteoporosisOsteoporosisOsteoporosis is a disease in which bones become fragile and more likely to break (fracture).ImageRead Article Now Book Mark Article Thyroid crisis or storm is an acute worsening of hyperthyroidism symptoms. It may occur with infection or stress. Thyroid crisis may cause:AcuteAcute means sudden or severe. Acute symptoms appear, change, or worsen rapidly. It is the opposite of chronic.ImageRead Article Now Book Mark Article 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 or swallowing. These complications are due to pressure on the airway passage (trachea) or esophagus, which lies behind the thyroid. When to Contact a Medical Professional Call your health care provider if you have symptoms of this disorder listed above. Follow the provider's instructions for follow-up visits. Prevention To prevent toxic nodular goiter, treat hyperthyroidism and simple goiter as your provider suggests.Open ReferencesReferencesHegedus L, Paschke R, Krohn K, Bonnema SJ. Multinodular goiter. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 90.Jonklaas J, Cooper DS. Thyroid. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 213.Kopp P. Autonomously functioning thyroid nodules and other causes of thyrotoxicosis. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 85.Ritter JM, Flower R, Henderson G, Loke YK, MacEwan D, Rang HP. The thyroid. In: Ritter JM, Flower R, Henderson G, Loke YK, MacEwan D, Rang HP, eds. Rang and Dale's Pharmacology. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 35.Smith PW, Hanks LR, Salomone LJ, Hanks JB. Thyroid. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 36.AllVideoImagesTogThyroid enlargement - scintiscan - illustration This image shows the enlargement of the thyroid gland and extension down behind the breastbone (retrosternal space). The image, called a scintiscan, was generated using a radioactive isotope.Thyroid enlargement - scintiscanillustrationThyroid gland - illustration The thyroid gland, a part of the endocrine (hormone) system, plays a major role in regulating the body's metabolism.Thyroid glandillustrationThyroid enlargement - scintiscan - illustration This image shows the enlargement of the thyroid gland and extension down behind the breastbone (retrosternal space). The image, called a scintiscan, was generated using a radioactive isotope.Thyroid enlargement - scintiscanillustrationThyroid gland - illustration The thyroid gland, a part of the endocrine (hormone) system, plays a major role in regulating the body's metabolism.Thyroid glandillustration Tests for Toxic nodular goiter T3 testTSH testRelated Information Simple goiter(Condition)Hyperthyroidism(Condition)Graves disease(Condition)Heart failure(Condition)Atrial fibrillation or flutter(Condition)Acute(Special Topic)Stress and your health(Symptoms)Heart failure(In-Depth)Anxiety disorders(In-Depth) Review Date: 1/26/2020 Reviewed By: Brent Wisse, MD, board certified in Metabolism/Endocrinology, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- © 1997- All rights reserved. A.D.A.M. content is best viewed in IE9 or above, Firefox and Google Chrome browser.Content is best viewed in IE9 or above, Firefox and Google Chrome browser.