Thyroid & parathyroid

Hyperplasia / goiter

Toxic goiter

Topic Completed: 1 March 2009

Minor changes: 31 December 2020

Copyright: 2003-2021,, Inc.

PubMed Search: toxic multinodular goiter thyroid

Shahid Islam, M.D., Ph.D.
Page views in 2020: 3,527
Page views in 2021 to date: 3,640
Cite this page: Islam S. Toxic goiter. website. Accessed December 7th, 2021.
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
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