Toxic multinodular goiter natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

• If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
• Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
• Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

Natural History, Complications, and Prognosis

Natural History

• If left untreated, toxic multinodular goiter may progress to develop hyperthyroidism.
• Untreated toxic multinodular goiter progresses slowly and initially presents with history of thyroid enlargement.
• Thyroid enlargement is followed by a long period of subclinical hyperthyroidism.
• Overt hyperthyroidism occurs late in the course of toxic multinodular goiter.
  • When hyperthyroidism is present, cardiac symptoms are the most common presentation such as palpitations, tachycardia, heart failure and atrial fibrillation.
  • Over the course of time, toxic multinodular goiter may increase in size and can lead to compression of surrounding structures such as trachea, esophagus or external jugular vein.

Complications

Common complications of toxic multinodular goiter include:

• Tachycardia
• Arrhythmia
• Atrial fibrillation
• Heart failure
• Facial plethora
• Inspiratory stridor
• Hoarseness
• Dysphagia
• Bone mineral loss
• Thyroid storm
• I-131-related hypothyroidism
• Surgery-related
  • Hypothyroidism
  • Recurrent laryngeal nerve damage
  • Hypoparathyroidism

Prognosis

• Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
• Depending on the extent of the [tumor/disease progression/etc.] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.
• The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy].
• [Subtype of disease/malignancy] is associated with the most favorable prognosis.
• The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.

• Prognosis of toxic multinodular goiter is generally good with treatment.
• About 45% to 75% of patients stay euthyroid following I-131 therapy.
• Both surgery and radioactive iodine therapy can confer a moderate long-term risk of hypothyroidism.
• Toxic multinodular goiter is commonly seen in elderly. Therefore, in elderly presence of other conditions may influence the outcome of toxic multinodular goiter.