Toxic multinodular goiter

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 subclinical 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 goiters.

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