Toxic Nodular Goiter

Toxic nodular goiter occurs when a simple nodule grows and begins to independently produce its own thyroid hormones, resulting in hyperthyroidism. It was first described in 1913 by American physician Henry Plummer and is also known as Plummer’s Disease.

It is the cause of 15-30 percent of all cases of hyperthyroidism in the United States.

Risk Factors

People at increased risk of having toxic nodular goiter are:

• Women
• Older people – most are over the age of 50

• Those with a family history of multi-nodular goiter
• People who have already had simple goiter

Symptoms

Symptoms of toxic nodular goiter are symptoms of hyperthyroidism such as enlarged thyroid gland, weight loss, palpitations, intolerance of heat and frequent bowel movements. The elderly may have constipation instead of frequent bowel movements.

Heart complications occur more frequently in the elderly. A very large goiter may cause hoarseness of voice or difficulty breathing and require surgical intervention.

Diagnosis

The doctor will perform a physical examination to see if the thyroid gland is enlarged. Nodules may be felt, but sometimes it is only possible to see them with the use of ultrasound. He will listen to your heart and check your reflexes, looking at the condition of your muscles and your complexion.

Blood tests will be given to check the levels of thyroid hormones, triiodothyronine (T3) and thyroxine (T4). These are elevated in hyperthyroidism. A thyroid scan will also show that the nodules are taking up increased amounts of iodine.

Treatment

Anti-thyroid drugs may be offered. These limit the ability of the thyroid (and nodules) to produce hormones. Radioactive iodine can destroy the thyroid to prevent it causing any more problems. If this is done, hormone replacement pills will be given.

Surgery can also be performed to remove the nodules and possibly the thyroid if necessary.

Sources:

Toxic nodular goiter, Medline Plus. Web. 24 January 2012. http://www.nlm.nih.gov/medlineplus/ency/article/000317.htm

Toxic Nodular Goiter, Medscape Reference. Web. 24 January 2012. http://emedicine.medscape.com/article/120497-overview

Plummer disease, Encyclopaedia of Britannica. Web. 24 January 2012. http://www.britannica.com/EBchecked/topic/465125/Plummer-disease

Joanna is a freelance health writer for The Mother magazine and Suite 101 with a column on infertility, http://infertility.suite101.com/. She is author of the book, 'Breast Milk: A Natural Immunisation,' and co-author of an educational resource on disabled parenting.

Reviewed January 25, 2012
by Michele Blacksberg RN
Edited by Jody Smith

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Tags:

• Thyroid Conditions