Multinodular Goiter

Aka: Multinodular Goiter, Toxic Multinodular Goiter, Non-Toxic Multinodular Goiter

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II. Epidemiology

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

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. Thyrotoxicosis
      1. Less severe than Grave disease or toxic adenoma
    3. Atrial Fibrillation
      1. More common than in other forms of Hyperthyroidism

VI. Findings

  1. Markedly enlarged nodular Thyroid (visible Goiter in 40%)
  2. Local compression of neck structures may occur
    1. Stridor
    2. Dyspnea
    3. Dysphagia or choking Sensation
    4. Hoarseness
  3. Toxic Multinodular Goiter
    1. See Hyperthyroidism

VII. Differential Diagnosis

  1. Thyroid Cancer

VIII. 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

IX. References

  1. Mounsey (2025) Am Fam Physician 112(2): 146-52 [PubMed]

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