Abstract
Introduction: Toxic multinodular goitre, first described by H.S. Plummer in 1913, is unremitting and often develops slowly, with more subtle symptoms than Graves’ disease. Cardiac symptoms such as tachycardia, heart failure, or arrhythmia and atrial fibrillation are most frequent. Here we describe a case who presented with symptoms of thyroid enlargement and heart failure. Case report: A 48-year old female presented to us with complaints of dysphagia, hoarseness of voice, breathlessness on exertion and palpitations since one month ago. Furthermore, the patient gave history of swelling of the neck which was initially pea sized and gradually increased to the current size over a period of two months. On examining the swelling of the neck, thyroid gland appears enlarged, firm with multiple nodules. Two-dimensional echocardiography revealed a dilated left ventricle with generalized hypokinesia. Computed Tomography of the neck suggested enlarged thyroid gland (12.1 cm × 6.5 cm) with heterogenous architecture, and thyroid gland encircling the trachea for approximately 270 degree with mass effect. Thyroid scan showed multinodular goitre with multiple hyperfunctioning nodules of both lobes and warm nodules only in left lobe. The patient was diagnosed as multinodular goitre with cardiomyopathy. The patient was treated medically with methimazole, propranolol, aspirin, ramipril, sustained release urodeoxycholic acid, rosuvastatin, pantoprazole and multivitamin. The patient underwent near total thyroidectomy with radioactive iodine ablation, as and when required. Conclusion: Patients with toxic multinodular goitre very frequently present with cardiovascular symptoms, which when identified and treated early can reduce the morbidity significantly.
Highlights
Toxic multinodular goitre, first described by H.S
We describe a case who presented with symptoms of thyroid enlargement and heart failure
The patient was diagnosed as multinodular goitre with cardiomyopathy
Summary
Toxic adenoma and toxic multinodular goitre are the second most common causes of hyperthyroidism, after Graves’ disease [1]. First described by H.S. Plummer in 1913, is unremitting and often develops slowly, with more subtle symptoms than Graves’ disease [2]. When the functional capacity of the thyroid follicular cells becomes independent of regulation by thyroid-stimulating hormone (TSH) focal and/or diffuse hyperplasia of thyroid follicular cells occurs, a long phase of subclinical hyperthyroidism can precede the appearance of overt symptoms. Cardiac symptoms such as tachycardia, heart failure, or arrhythmia and atrial fibrillation are most frequent. We describe a case, who presented with symptoms of thyroid enlargement and heart failure
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