Toxic Nodular GoiterSymptoms, Doctors, Treatments, Advances & More
Learn About Toxic Nodular Goiter
Toxic nodular goiter involves an enlarged thyroid gland. The gland contains areas that have increased in size and formed nodules. One or more of these nodules produce too much thyroid hormone.
Toxic multinodular goiter; Plummer disease; Thyrotoxicosis - nodular goiter; Overactive thyroid - toxic nodular goiter; Hyperthyroidism - toxic nodular goiter; Toxic multinodular goiter; MNG
Toxic nodular goiter starts from an existing simple goiter. It occurs most often in older adults. Risk factors include being female and over 55 years old. This disorder is rare in children. Most people who develop it have had a goiter with nodules for many years. Sometimes the thyroid gland is only slightly enlarged, and the goiter was not already diagnosed.
Sometimes, people with toxic multinodular goiter will develop high thyroid hormone levels for the first time after:
- Taking iodine through a vein (intravenously) or by mouth. The iodine may be used as contrast for a CT scan or heart catheterization (most common).
- Taking medicines that contain iodine, such as amiodarone.
- Moving from a country with iodine deficiency to a country with a lot of iodine in the diet.
Symptoms may include any of the following:
- Fatigue
- Frequent bowel movements
- Heat intolerance
- Increased appetite
- Increased sweating
- Irregular menstrual period (in women)
- Muscle cramps
- Nervousness
- Restlessness
- Weight loss
Older adults may have symptoms that are less specific. These may include:
- Weakness and fatigue
- Palpitations and chest pain or pressure
- Changes in memory and mood
Toxic nodular goiter does not cause the bulging eyes that can occur with Graves disease. Graves disease is an autoimmune disorder that leads to an overactive thyroid gland (hyperthyroidism) without any nodules.
Beta-blockers can control some of the symptoms of hyperthyroidism until thyroid hormone levels in the body are under control.
Certain medicines can block or change how the thyroid gland uses iodine. These may be used to control the overactive thyroid gland in any of the following cases:
- Before surgery or radioiodine therapy occurs
- As a long term treatment
Radioiodine therapy may be used. Radioactive iodine is given by mouth. It concentrates in the overactive thyroid tissue and causes damage. In some cases, thyroid hormone replacement is needed afterward.
Surgery to remove the thyroid may be done when:
- A very large goiter or a goiter is causing symptoms by making it hard to breathe or swallow
- Thyroid cancer is present
- Rapid treatment is needed
Jerry & Kathleen Grundhofer Clinic - Diabetes & Endocrinology
Claudia Fish, MD, is an endocrinologist practicing at Intermountain Health’s Round Valley Clinic in Park City, Utah. She supports patients in Summit County, Heber Valley, and surrounding communities, treating thyroid disease, osteoporosis, diabetes, and more. Her clinical interests are deeply rooted in health and nutrition, which she passionately pursues to enhance the well-being of her patients.Claudia has dedicated her career to the study and treatment of thyroid disease, osteoporosis, and diabetes. Her approach to patient care is guided by her belief that knowledge is power, ensuring that her patients are well-informed and empowered in their health journeys.Outside of her professional life, Claudia, a Buffalo, NY native enjoys running, biking, baking, entertaining, and traveling. She believes that knowledge is power, a philosophy that guides her approach to patient care.Conditions Treated: Thyroid disease:Hyperthyroidism, Hypothyroidism, NodulesPituitary DiseaseUltrasound guided biopsy of Thyroid NodulesOsteoporosisDiabetes: Type 1 Diabetes: Insulin pumpsProcedures Performed: Thyroid UltrasoundUltrasound guided Thyroid Nodule BiopsiesInjections and Infusions for Osteoporosis. Dr. Fish is rated as a Distinguished provider by MediFind in the treatment of Toxic Nodular Goiter. She is also highly rated in 19 other conditions, according to our data. Her clinical expertise encompasses Osteoporosis, Postmenopausal Osteoporosis, Toxic Nodular Goiter, and Type 2 Diabetes (T2D). Dr. Fish is board certified in American Board Of Radiology. Dr. Fish is currently accepting new patients.
Reading Hospital Endocrinology & Diabetes Center Wyomissing
. Dr. Gabriely is rated as an Advanced provider by MediFind in the treatment of Toxic Nodular Goiter. He is also highly rated in 59 other conditions, according to our data. His clinical expertise encompasses Low Blood Sugar, Hyperparathyroidism, Thyroid Cancer, and Anaplastic Thyroid Cancer. Dr. Gabriely is board certified in American Board Of Internal Medicine.
Malgorzata Szelachowska practices practicing medicine in Bialystok, Poland. Ms. Szelachowska is rated as an Elite expert by MediFind in the treatment of Toxic Nodular Goiter. She is also highly rated in 4 other conditions, according to our data. Her clinical expertise encompasses Toxic Nodular Goiter, Hyperthyroidism, Type 1 Diabetes (T1D), and Graves Disease.
Toxic nodular goiter is mainly a disease of older adults. So, other chronic health problems may affect the outcome of this condition. An older adult may be less able to tolerate the effect of the disease on the heart. However, the condition is often treatable with medicines.
Heart complications:
- Heart failure
- Irregular heartbeat (atrial fibrillation)
- Rapid heart rate
Other complications:
- Bone loss leading to osteoporosis
Thyroid crisis or storm is a sudden worsening of hyperthyroidism symptoms. It may occur with infection or stress. Thyroid crisis may cause:
- Abdominal pain
- Decreased mental alertness
- Fever
People with this condition need to go to the hospital right away.
Complications of having a very large goiter may include difficulty breathing or swallowing. This is due to pressure on the airway passage (trachea) or esophagus, which lies behind the thyroid.
Contact your health care provider if you have symptoms of this disorder listed above. Follow your provider's instructions for follow-up visits.
To prevent toxic nodular goiter, treat hyperthyroidism and simple goiter as your provider suggests.
Summary: The purpose of this study is to assess if preoperative treatment with Lugol's solution prior to thyroidectomy can reduce the surgical complications hypoparathyroidism and laryngeal nerve palsy
Published Date: January 25, 2026
Published By: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Alexander EK, Haymart MR, Pattison DA, Wirth LJ, Zeiger MA. Nontoxic diffuse goiter, nodular thyroid disorders, and thyroid malignancies. In: Melmed S, Auchus RJ, Goldfine AB, Rosen CJ, Kopp PA, eds. Williams Textbook of Endocrinology. 15th ed. Philadelphia, PA: Elsevier; 2025:chap 12.
Pearce EN, Hollenberg AN. Thyroid. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 207.
Ullmann T, Kim J, Lindeman B, Sosa JA. The Thyroid. In: Tyler DS, Hayes-Dixon A, Hines OJ, et al, eds. Sabiston Textbook of Surgery. 22nd ed. Philadelphia, PA: Elsevier; 2026:chap 73.