Toxic multinodular goitre
|Toxic multinodular goiter|
|Classification and external resources|
It is a common cause of hyperthyroidism in which there is excess production of thyroid hormones from functionally autonomous thyroid nodules, which do not require stimulation from thyroid stimulating hormone (TSH).
It is the second most common cause of hyperthyroidism (after Graves' disease) in the developed world. In countries where the population is iodine-deficient i.e. the developing world, iodine deficiency is the most common cause of hypothyroidism. (Decreased iodine leads to decreased thyroid hormone.) However, iodine deficiency can cause goitre (thyroid enlargement); within a goitre, nodules can develop. Risk factors for toxic multinodular goiter include individuals over 60 years of age and being female.
Signs and symptoms
- heat intolerance
- muscle weakness/wasting
- weight loss
- increased appetite
- non-painful goitre (swelling of the thyroid gland)
- tachycardia (high heart rate - above 100 beats per minute at rest in adults)
Sequence of events:
- Iodine deficiency leading to decreased T4 production.
- Induction of thyroid cell hyperplasia due to low levels of T4. This accounts for the multinodular goitre appearance.
- Increased replication predisposes to a risk of mutation in the TSH receptor.
- If the mutated TSH receptor is constitutively active, it would then become 'toxic' and produces excess T3/T4 leading to hyperthyroidism.
Another treatment option is injection of ethanol into the nodules.
Plummer's disease is named after the American physician Henry Stanley Plummer but refers to a single toxic nodule (adenoma) which may present with the background of a suppressed multinodular goitre.
- de Rooij, A; Vandenbroucke, JP; Smit, JW; Stokkel, MP; Dekkers, OM (2009). "Clinical outcomes after estimated versus calculated activity of radioiodine for the treatment of hyperthyroidism: systematic review and meta-analysis.". European Journal of Endocrinology. Bioscientifica. 161 (5): 771–777. doi:10.1530/EJE-09-0286. PMID 19671708.
- Krohn, K; Fuhrer, D; Bayer, Y; Eszlinger, M; Brauer, V; Neumann, S; Paschke, R (2005). "Molecular pathogenesis of euthyroid and toxic multinodular goiter.". Endocrine Reviews. 26 (4): 504–524. doi:10.1210/er.2004-0005. PMID 15615818.
- Reid, JR; Wheeler, SF (2005). "Hyperthyroidism: diagnosis and treatment.". American family physician. 72 (4): 623–630. PMID 16127951.
- A.D.A.M. Medical Encyclopedia (2012). "Toxic nodular goiter". U.S. National Library of Medicine. Retrieved 30 January 2013.
- Toxic Nodular Goiter at eMedicine
- al.], senior editors, J. Larry Jameson, Leslie J. De Groot ; section editors, David de Kretser ... [et (2010). Endocrinology : adult and pediatric (6th ed.). Philadelphia: Saunders/Elsevier. p. Chapter 82. ISBN 9781416055839.
- Plummer's disease eponymously named after Henry Stanley Plummer at Who Named It?