Toxic multinodular goitre

Toxic multinodular goitre (TMNG), also known as Plummer's disease, is a condition characterized by an enlarged thyroid gland with multiple nodules that produce excess thyroid hormone, leading to hyperthyroidism. This condition is more common in older adults and in regions with iodine deficiency.

Signs and symptoms

The symptoms of toxic multinodular goitre are primarily those of hyperthyroidism and may include:

• Weight loss
• Tremors
• Palpitations
• Heat intolerance
• Increased appetite
• Nervousness
• Goitre (enlarged thyroid gland)

Complications

If left untreated, toxic multinodular goitre can lead to serious complications such as:

• Thyroid storm – a life-threatening exacerbation of hyperthyroidism
• Atrial fibrillation – an irregular and often rapid heart rate
• Osteoporosis – weakened bones due to excessive thyroid hormone

Causes

The exact cause of toxic multinodular goitre is not fully understood, but it is believed to be related to:

• Iodine deficiency
• Genetic factors

Diagnosis

Diagnosis of toxic multinodular goitre typically involves:

• Thyroid function tests – to measure levels of thyroid hormones and thyroid-stimulating hormone (TSH)
• Ultrasound – to visualize the thyroid gland and detect nodules
• Radioactive iodine uptake test – to assess the function of the thyroid nodules

Differential diagnosis

Conditions that may present similarly and need to be differentiated from toxic multinodular goitre include:

• Graves' disease
• Thyroiditis

Treatment

Treatment options for toxic multinodular goitre include:

• Antithyroid medication – such as methimazole or propylthiouracil
• Radioactive iodine therapy – to reduce the activity of the thyroid gland
• Thyroidectomy – surgical removal of part or all of the thyroid gland

See also

• Hyperthyroidism
• Goitre
• Thyroid function tests
• Thyroidectomy