II. Epidemiology

  1. Toxic Multinodular Goiter is second most common cause of Hyperthyroidism in U.S. (5% of cases)

III. Risk Factors

  1. Diets deficient in Iodine (esp. elderly)

IV. Causes

  1. Simple Goiter develops into Multinodular Goiter

V. Types

  1. Non-Toxic Multinodular Goiter
  2. Toxic Multinodular Goiter (50%)
    1. Increase in clonogenic cells with TSH receptor mutation (somatic activating)
    2. Results in Thyrotoxicosis

VI. Differential Diagnosis

VII. Symptoms

VIII. Signs

  1. Markedly enlarged nodular Thyroid
  2. Stridor

IX. Complications

  1. Toxic Multinodular Goiter (Thyrotoxicosis)
    1. Cardiovascular complications
      1. Atrial Fibrillation
      2. Tachycardia
      3. Congestive Heart Failure
    2. No Ophthalmopathy (Proptosis and stare)
    3. No Dermopathy
  2. Both Toxic and Non-Toxic Multinodular Goiter
    1. Superior Vena Cava Syndrome
      1. Results from thoracic outlet obstruction

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