Thyroid

Multinodular Goiter

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Multinodular Goiter, Toxic Multinodular Goiter, Non-Toxic Multinodular Goiter

  • See Also
  1. Hyperthyroidism
  • Epidemiology
  1. Toxic Multinodular Goiter is second most common cause of Hyperthyroidism in U.S. (5% of cases)
  2. More common in older patients
  • Risk Factors
  1. Diets deficient in Iodine (esp. elderly)
  • Causes
  1. Simple Goiter develops into Multinodular Goiter
  • Types
  1. Non-Toxic Multinodular Goiter
  2. Toxic Multinodular Goiter (50%)
    1. Increase in clonogenic cells with TSH receptor mutation (somatic activating)
    2. Thyrotoxicosis
      1. Less severe than Grave disease or toxic adenoma
    3. Atrial Fibrillation
      1. More common than in other forms of Hyperthyroidism
  • Findings
  1. Markedly enlarged nodular Thyroid (visible Goiter in 40%)
  2. Local compression of neck structures may occur
    1. Stridor
    2. Dyspnea
    3. Dysphagia or choking Sensation
    4. Hoarseness
  3. Toxic Multinodular Goiter
    1. See Hyperthyroidism
  • Differential Diagnosis
  1. Thyroid Cancer
  • Complications
  1. Toxic Multinodular Goiter (Thyrotoxicosis)
    1. Cardiovascular complications
      1. Atrial Fibrillation
      2. Tachycardia
      3. Congestive Heart Failure
    2. No Ophthalmopathy (Proptosis and stare)
    3. No Dermopathy
  2. Both Toxic and Non-Toxic Multinodular Goiter
    1. Superior Vena Cava Syndrome
      1. Results from thoracic outlet obstruction
  • References
  1. Mounsey (2025) Am Fam Physician 112(2): 146-52 [PubMed]