Toxic multinodular goitre
| Toxic multinodular goiter | |
|---|---|
| Classification and external resources | |
| Specialty | Endocrinology |
| ICD-10 | E05.2 |
| ICD-9-CM | 242.3 |
| DiseasesDB | 13184 |
| MedlinePlus | 000317 |
| eMedicine | med/920 |
| Patient UK | Toxic multinodular goitre |
Toxic multinodular goiter (also known as toxic nodular goiter, toxic nodular struma, or Plummer's disease) is a multinodular goiter associated with a hyperthyroidism.
It is a common cause of hyperthyroidism[1][2] in which there is excess production of thyroid hormones from functionally autonomous thyroid nodules, which do not require stimulation from thyroid stimulating hormone (TSH).[3]
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.[4]
Signs and symptoms
Symptoms of toxic multinodular goitre are similar to that of hyperthyroidism, including:[4]
- heat intolerance
- muscle weakness/wasting
- hyperactivity
- fatigue
- tremor
- irritability
- weight loss
- osteoporosis
- increased appetite
- non-painful goitre (swelling of the thyroid gland)
- tachycardia (high heart rate - above 100 beats per minute at rest in adults)
Causes
Sequence of events:[5]
- 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.
Treatments
Toxic multinodular goiter can be treated with antithyroid medications such as propylthiouracil or methimazole, radioactive iodine, or with surgery.[4]
Another treatment option is injection of ethanol into the nodules.[6]
Related eponym
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.[7]
References
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- ↑ Toxic Nodular Goiter at eMedicine
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- ↑ Plummer's disease eponymously named after Henry Stanley Plummer at Who Named It?
