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Toxic multinodular goiter is diagnosed with a physical examination which shows nodules in the throat and rapid heart rate, among other signs such as diaphoresis, tremors, blood screening includes tests for elevated T3 and T4 hormone levels that indicate hyperthyroidism. Low levels of thyroid-stimulating hormone (TSH) are suggestive of hyperthyroidism overactive nodules are found on ultrasound scans of the thyroid to create images of the thyroid, which can reveal the conjunction with a special radioactive iodine test that involves swallowing a pill prior to special scans.