Toxic Multinodular Goiter

Clinical Presentation and Diagnosis

• The American College of Radiology suggests that thyrotoxicosis confirmed by biochemistry, with a suppressed TSH and negative TSH receptor antibodies, rules out Graves' disease in patients with toxic multinodular goiter 1, 2
• The characteristic radioactive iodine uptake scan showing multiple areas of both increased and suppressed uptake is a hallmark pattern of autonomous functioning nodules interspersed with suppressed normal thyroid tissue, according to the American College of Radiology 1
• The radioiodine scan pattern is pathognomonic, with multiple areas of increased uptake (hot nodules) and intervening areas of suppressed uptake, representing autonomous functioning nodules that have suppressed the surrounding normal thyroid tissue 1, 3

Management and Treatment

• The American Heart Association, as published in Circulation, indicates that palpitations in children with thyrotoxicosis can lead to cardiac complications, including arrhythmias, emphasizing the need for urgent treatment 4
• The American College of Radiology recommends that definitive treatment planning should include surgery (thyroidectomy) as the preferred definitive treatment in children with toxic multinodular goiter, as it provides immediate cure and allows for rapid restoration of normal thyroid function 1