Multinodular toxic goiter vs Nonnodular toxic goiter;

Toxic goiter vs non toxic goiter

A multinodular goiter is simply a late-stage goiter, meaning a goiter thats been around
for a while and has had a chance to grow and become lumpy. Goiter simply means
enlarged thyroid so you can technically use the term any time a patient has a big
thyroid (like, for example, patients with Graves disease). In this context, however, with
the word multinodular attached, it means a goiter that is caused by an inability to
produce thyroid hormone (which can happen for many reasons; in underdeveloped
countries its commonly because of iodine deficiency, whereas in this country the
reasons are often unclear). A low T4 level causes the pituitary to secrete more TSH,
which makes the thyroid grow bigger (hence, the goiter). As this process evolves, some
areas of the thyroid are growing and trying to produce thyroid hormone and others are
not growing, but involuting. Repeated cycles of growth and involution can damage the
thyroid, and as it repairs itself, fibrosis occurs, leading to a lumpy, nodular appearance
in the goiter.
Toxic means that the thyroid is producing thyroid hormone at an increased rate. The
term toxic multinodular goiter is loosely used to describe any lumpy thyroid that is
producing excess thyroid hormone. This could occur in a thyroid adenoma thats
producing thyroid hormone (and which appears clinically as a lump) or it could occur
within the context of a true multinodular goiter. Sometimes, for reasons that are not
clear, a nodule within a multinodular goiter can sort of break away and start producing
thyroid hormone autonomously (without the input of TSH). In these instances, the
patient may actually become hyperthyroid.
A nontoxic goiter is a diffuse or nodular enlargement of the thyroid gland that does not
result from an inflammatory or neoplastic process and is not associated with
abnormal thyroid function. Endemic goiter is defined as thyroid enlargement that occurs
in more than 10% of a population, and sporadic goiter is a result of environmental or
genetic factors that do not affect the general population.