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 TSH 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 (TSH) and are almost always benign. However, nonfunctioning thyroid nodules in the same goiter may be malignant.
Associate Professor of Medicine
Boston University Medical Center
ENP has received honoraria and travel funding for speaking at two international conferences for Merck Serono and at one for IBSA. She is a member of the Management Council of the Iodine Global Network. She is an author of a number of references cited in this monograph.
Dr Elizabeth N. Pearce would like to gratefully acknowledge Dr Sheila Feit, a previous contributor to this monograph. SF is an employee of the BMJ Group.
PP declares that he has no competing interests.
Professor of Surgery
Virginia Commonwealth University
RM declares that he has no competing interests.
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