Toxic multinodular goitre

Most common in older patients.

Onset of symptoms is more insidious and symptoms less dramatic than for Graves' disease. Patients may have apathetic hyperthyroidism (minimal signs/symptoms) or sub-clinical hyperthyroidism (isolated thyroid-stimulating hormone suppression).

Spontaneous remission is rare. Definitive treatment, most commonly radioactive iodine, is usually required.

If untreated, complications may include sequelae of hyperthyroidism, such as cardiac dysfunction or bone loss, or tracheal compression by large goitres.

A toxic multinodular goitre (MNG; also known as Plummer's disease) contains multiple autonomously functioning nodules, resulting in hyperthyroidism. These nodules function independently of thyroid-stimulating hormone and are almost always benign. However, non-functioning thyroid nodules in the same goitre may be malignant.