Toxic nodular goiter refers to an enlarged thyroid gland, or goiter, that contains multiple nodules that hypersecrete thyroid hormone. Hypersecretion of thyroid hormone causes hyperthyroidism. Toxic nodular goiters occur commonly in the elderly and usually arise from long-present goiter. Symptoms of toxic nodular goiter may include weight loss, nervousness, anxiety, high blood pressure, increased appetite, increased perspiration, fatigue, frequent bowel movements, muscle cramping, and menstrual irregularities.
Symptoms of toxic nodular goiter are similar to hyperthyroidism, with the exception of protruding or bulging eyeballs that are a frequent manifestation of Grave's hyperthyroidism. Risk factors of toxic nodular goiter include being over 60 years of age and being female. Toxic nodular goiters rarely are seen in children and their cause is unknown.
Diagnostic tests that may indicate toxic nodular goiter include a physical examination which may reveal multiple nodules and a rapid pulse or heart rate. A thyroid scan can be useful in diagnosing toxic multi-nodular goiter, because radioactive iodine contrast material that is given prior to the test typically will present itself in the nodules. Blood tests that may indicate nodular toxic goiter include serum thyroid stimulating hormone levels and serum thyroid hormone levels.
Toxic nodular goiter treatment may include taking radioactive iodine, surgery to remove the thyroid gland, or antithyroid medications. Beta blockers, which are cardiac medications usually given to regulate heart rate, may be given to control symptoms of hyperthyroidism such as palpitations and nervousness. Beta blockers may be a transient treatment, used only until antithyroid medications have regulated hormone levels.
The prognosis of toxic nodular goiter usually is dependent upon other predisposing risk factors the patient may have. Since this condition typically is one found in the elderly, other medical problems may influence the prognosis. The elderly patient may be less tolerant of cardiac symptoms such as palpitations, and may not be as responsive to treatment. Medications that the patient is taking may interact or be contraindicated with thyroid medications.
Complications relating to toxic nodular goiter may include congestive heart failure and atrial fibrillation. Atrial fibrillation is a cardiac condition where the heart beats rapidly and irregularly. A severe complication of toxic nodular goiters is thyroid crisis or thyroid storm. Thyroid storm is an extreme worsening of the symptoms of hyperthyroidism which may occur as a result of acute infection or stress. Thyroid storm may require hospitalization due to decreased levels of alertness, fever, abdominal pain, and erratic heartbeat.