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Toxic Multinodular Goiter

 Syn. Secondary thyroid hyperplasia , Toxic multinodular thyroid goiter

Signs & Symptoms

 Unilateral thyroid abnormalities (negative symptom)
Ref: Uptodate [ Clinical presentation and evaluation of goiter in adults]
Unexplained weight loss
Note: due to Hyperthyroidism
Ref: Uptodate [ Clinical presentation and evaluation of goiter in adults] Harrison [ 2712]
Cold intolerance
Note: due to hypothyroidism
Ref: Uptodate [ Clinical presentation and evaluation of goiter in adults]
Palpitations
Note: due to Hyperthyroidism
Ref: Uptodate [ Clinical presentation and evaluation of goiter in adults] Harrison [ 2712]

Physical Examination

 Extraordinarily large thyroid gland
Note: due to Multinodular goiter with autonomy, due to Graves disease
Ref: Harrison [ 2711]
Thyroid bruit
Note: due to Hyperthyroidism, due to Graves disease
Ref: Uptodate [ Clinical presentation and evaluation of goiter in adults] Cecil [ 639]
Thyroid tenderness (negative symptom)
Ref: Uptodate [ Clinical presentation and evaluation of goiter in adults]

Lab / Serology

 Elevated TPO antibodies
Note: due to Autoimmune thyroiditis
Ref: Uptodate [ Clinical presentation and evaluation of goiter in adults] Harrison [ 2711] Cecil [ 639]
Iodine deficiency
Note: The most common cause of nontoxic goiter
Ref: Uptodate [ Clinical presentation and evaluation of goiter in adults] Harrison [ 2710] Cecil [ 639]
Low urinary iodine levels
Note: <50 μg/L, In patients with iodine deficiency
Ref: Harrison [ 2711]

Imagin Study

 Microcalcifications (negative symptom)
Ref: Harrison [ 2712]
Taller than wide shape on transverse view (negative symptom)
Ref: Harrison [ 2712]
Marked hypoechogenicity (negative symptom)
Ref: Harrison [ 2711]

Complication

Risk Factors

 Female
Ref: Harrison [ 2711]
Elder
Ref: Harrison [ 2712]

Cause

 Iodine deficiency
Note: The most common cause of nontoxic goiter
Ref: Uptodate [ Clinical presentation and evaluation of goiter in adults] Harrison [ 2710] Cecil [ 639]
Graves disease
Note: In US
Ref: Uptodate [ Clinical presentation and evaluation of goiter in adults] Harrison [ 2710]
Chronic autoimmune thyroiditis
Note: In US
Ref: Uptodate [ Clinical presentation and evaluation of goiter in adults] Harrison [ 2710]

Other