Thyroid & parathyroid
Hyperplasia / goiter
Toxic goiter
Author: Shahid Islam, M.D., Ph.D.
Last author update: 1 March 2009
Last staff update: 31 December 2020
Copyright: 2003-2024, PathologyOutlines.com, Inc.
PubMed Search: toxic multinodular goiter thyroid
Table of Contents
Definition / general | Terminology | Epidemiology | Clinical features | Laboratory | Treatment | Gross description | Microscopic (histologic) description | Molecular / cytogenetics description | Differential diagnosis | Additional referencesCite this page: Islam S. Toxic goiter. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/thyroidtoxicmultinodulargoiter.html. Accessed April 23rd, 2024.
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)
Terminology
- Also called Plummer's disease (particularly if single nodule)
- Toxic nodular goiter: also called toxic adenoma, may arise in background of multinodular goiter
Epidemiology
- 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
Laboratory
- Slight increase in T3 / T4 (less than Graves disease), reduced TSH
Treatment
- Radioactive iodine, total thyroidectomy if obstructive symptoms or large (World J Surg 2008;32:1278)
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
- Dyshormonogenetic goiter: diffuse changes compared to focal changes in toxic multinodular goiter
- Follicular carcinoma: vascular invasion or invasion beyond thyroid gland
- Graves disease: uniformly enlarged gland with uniformly diffuse hyperplasia and no nodules
- Nontoxic multinodular goiter: difficult to distinguish histologically, need imaging studies and clinical correlation
Additional references
