Introduction 

Toxic multinodular goiter refers to autonomous hyperfunctioning thyroid nodules that produce hyperthyroidism 

-it is more common in women over the age of 60 and in iodine-deficient regions

-it is the second most common cause of hyperthyroidism after Graves disease 

Symptoms & Signs 

Symptoms and signs of hyperthyroidism are similar to Graves’ disease: weight loss, nervousness, weakness, tremors, sweats, tachycardia, heart failure, arrhythmias, atrial fibrillation, congestive heart failure 

Physical examination reveals a multinodular goiter which may extend substernally

Diagnosis 

Labs: low or undetectable TSH, elevation in serum serum T3 levels, with less striking elevation of serum T4

Radioiodine scan: multiple functioning nodules in the gland with iodine localized to active nodules

Treatment 

methimazole (preferable) or propylthiouracil followed by subtotal thyroidectomy; RAI therapy