Alternate Names: Plummer's disease

Causes and Risks:

Toxic nodular goiter arises from a long-standing simple goiter and occurs most often in the elderly. Symptoms are those of hyperthyroidism, but 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.

Prevention:

Treat hyperthyroidism and simple goiter as per your health care provider’s recommendations.

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.

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

Treatment:

Radioactive iodine 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 the thyroid hormone level in the body is under control.

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 complications include rapid heart rate, congestive heart failure, and atrial fibrillation (a rapid and irregular heart rhythm).

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 indicated.

Call for an appointment with your health care provider if symptoms of this disorder occur. Follow the health care provider’s recommendations for follow-up visits.