Thyroid gland
Hyperplasia / goiter
Toxic multinodular goiter

Author: Shahidul Islam, M.D., Ph.D. (see Authors page)

Revised: 24 January 2017, last major update March 2009

Copyright: (c) 2003-2017,, Inc.

PubMed Search: toxic multinodular goiter thyroid
Cite this page: Toxic multinodular goiter. website. Accessed June 20th, 2018.
Definition / general
  • Multinodular goiter plus hyperthyroidism ("toxic")
  • #2 cause of hyperthyroidism after Graves disease, #1 in elderly, particularly in iodine deficient areas (J Endocrinol Invest 2002;25:16)
  • Also called Plummer's disease (particularly if single nodule)
  • Toxic nodular goiter: also called toxic adenoma, may arise in background of multinodular goiter
  • Usually older patients rather than those with nontoxic multinodular goiter, with long evolution time (Surg Today 2005;35:901)
Clinical features
  • Associated with atrial fibrillation, tachycardia, weakness and muscle wasting, only rarely with eye disease
  • Slight increase in T3 / T4 (less than Graves disease), reduced TSH
Gross description
  • Enlarged thyroid gland with multiple nodules exhibiting fibrosis, old and new hemorrhage and dystrophic calcification
Microscopic (histologic) description
  • Hyperplastic nodules with discrete fibrous capsule, composed of follicles with papillary hyperplasia and tall columnar cells
  • Nonfunctioning nodules may appear inactive and have degenerative changes of fibrosis, calcification and hemorrhage (old and new)
Molecular / cytogenetics description
  • Monoclonal or polyclonal
Differential diagnosis
Additional references