What is Toxic Nodular Goiter?

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  • Written By: Madeleine A.
  • Edited By: J.T. Gale
  • Last Modified Date: 29 September 2019
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Toxic nodular goiter refers to an enlarged thyroid gland, or goiter, that contains multiple nodules that hypersecrete thyroid hormone. Hypersecretion of thyroid hormone causes hyperthyroidism. Toxic nodular goiters occur commonly in the elderly and usually arise from long-present goiter. Symptoms of toxic nodular goiter may include weight loss, nervousness, anxiety, high blood pressure, increased appetite, increased perspiration, fatigue, frequent bowel movements, muscle cramping, and menstrual irregularities.

Symptoms of toxic nodular goiter are similar to hyperthyroidism, with the exception of protruding or bulging eyeballs that are a frequent manifestation of Grave's hyperthyroidism. Risk factors of toxic nodular goiter include being over 60 years of age and being female. Toxic nodular goiters rarely are seen in children and their cause is unknown.

Diagnostic tests that may indicate toxic nodular goiter include a physical examination which may reveal multiple nodules and a rapid pulse or heart rate. A thyroid scan can be useful in diagnosing toxic multi-nodular goiter, because radioactive iodine contrast material that is given prior to the test typically will present itself in the nodules. Blood tests that may indicate nodular toxic goiter include serum thyroid stimulating hormone levels and serum thyroid hormone levels.


Toxic nodular goiter treatment may include taking radioactive iodine, surgery to remove the thyroid gland, or antithyroid medications. Beta blockers, which are cardiac medications usually given to regulate heart rate, may be given to control symptoms of hyperthyroidism such as palpitations and nervousness. Beta blockers may be a transient treatment, used only until antithyroid medications have regulated hormone levels.

The prognosis of toxic nodular goiter usually is dependent upon other predisposing risk factors the patient may have. Since this condition typically is one found in the elderly, other medical problems may influence the prognosis. The elderly patient may be less tolerant of cardiac symptoms such as palpitations, and may not be as responsive to treatment. Medications that the patient is taking may interact or be contraindicated with thyroid medications.

Complications relating to toxic nodular goiter may include congestive heart failure and atrial fibrillation. Atrial fibrillation is a cardiac condition where the heart beats rapidly and irregularly. A severe complication of toxic nodular goiters is thyroid crisis or thyroid storm. Thyroid storm is an extreme worsening of the symptoms of hyperthyroidism which may occur as a result of acute infection or stress. Thyroid storm may require hospitalization due to decreased levels of alertness, fever, abdominal pain, and erratic heartbeat.


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Post 4

I was diagnosed with toxic goiter last year. I've been taking medications and lately, I was admitted to the hospital due to chest pain. According to the doctor, I have irregular heart beat and the covering of my heart has arthritis. Is this possible in my condition? I need your answer badly.

Post 3

Is toxic nodular goiter the most difficult and chronic kind of thyroid disorder?

I'm studying about the different kinds of thyroid disorders for my class and toxic nodular goiter seems hard to treat.

We've already studied lymphocytic thyroids and granulomatous thyroids. Both are temporary conditions and can go back to normal on its own or with drug treatments. But from what I understand when there are toxic nodules, it stays that way and continues to produce excessive hormone. It can be suppressed with drugs to some extent, but the best treatment seems to be surgery which is rarely required for other thyroid disorders.

Am I right?

Post 2

@simrin-- I've had elevated thyroid hormones for several years but I was diagnosed a short time ago with toxic nodular goiter. I'm currently taking meds and being monitored once a month to see how I'm responding. It's too early for me to know if I will need radioactive iodine or surgery.

My condition is suitable for the radioactive iodine treatment though. I only have one nodule and I'm over 45 years old. They don't give this treatment for people who are younger than that, and I've heard that it's not very effective for multinodular goiter. But you should ask your doctor about that to make sure.

If you're really against surgery and if you don't respond to the medications, you will probably have to have the radioactive iodine treatment.

Post 1

I was diagnosed with toxic multinodular goiter last week. Went to my endocrinologist because of weight loss and anxiety and he found the nodules during the physical examination. An ultrasound confirmed that it's toxic nodular goiter.

I'm expected to decide on a treatment to go with pretty soon. It's either going to be iodine, surgery or medications. I don't know much about any of these treatments nor their risks and benefits. So I'm confused and unsure about what to do.

I don't think I want to have surgery. I think that it's probably wise for me to try the medications first and maybe take some anti-anxiety medication while those kick in.

Is anyone else being treated for this condition right now? Which treatment are you on?

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