Toxic multinodular goiter

Abstract

Toxic multinodular goiter is a heterogeneous disorder characterized by multiple autonomous nodules with varying degrees of thyroid hormone production. It is a common cause of hyperthyroidism in adults, with increased prevalence in areas of iodine deficiency and with advancing age. Toxic multinodular goiter often develops from long-standing goiters that acquire somatic mutations of the TSH receptor or the GSA protein, leading to formation of multiple nodules with variable degrees of autonomous functioning. Patients may present with subclinical or overt hyperthyroidism, or with obstructive symptoms related to enlarging goiter. Treatment should be initiated in the setting of large goiters causing obstructive symptoms or thyrotoxicosis. The mainstays of treatment are surgical resection and radioactive iodine ablation.