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TOXIC MULTINODULAR GOITER AND TOXIC ADENOMA is a topic covered in the Harrison's Manual of Medicine.

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In addition to features of goiter, the clinical presentation of toxic MNG includes subclinical hyperthyroidism or mild thyrotoxicosis. The pt is usually elderly and may present with atrial fibrillation or palpitations, tachycardia, nervousness, tremor, or weight loss. Recent exposure to iodine, from contrast dyes or other sources, may precipitate or exacerbate thyrotoxicosis; this may be prevented by prior administration of an antithyroid drug. The TSH level is low. T4 may be normal or minimally increased; T3 is often elevated to a greater degree than T4. Thyroid scan shows heterogeneous uptake with multiple regions of increased and decreased uptake; 24-h uptake of radioiodine may not be increased. Cold nodules in a MNG should be evaluated in the same way as solitary nodules (see below). Antithyroid drugs, often in combination with beta blockers, can normalize thyroid function and improve clinical features of thyrotoxicosis but do not induce remission. A trial of radioiodine should be considered before subjecting pts, many of whom are elderly, to surgery. Subtotal thyroidectomy provides definitive treatment of goiter and thyrotoxicosis. Pts should be rendered euthyroid with antithyroid drugs before surgical intervention.

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Loscalzo, Joseph, et al., editors. "TOXIC MULTINODULAR GOITER and TOXIC ADENOMA." Harrison's Manual of Medicine, 19th ed., McGraw Hill Inc., 2017. harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623421/all/TOXIC_MULTINODULAR_GOITER_AND_TOXIC_ADENOMA.
TOXIC MULTINODULAR GOITER AND TOXIC ADENOMA. In: Loscalzo J, Jameson JL, Longo DL, et al, eds. Harrison's Manual of Medicine. 19th ed. McGraw Hill Inc.; 2017. https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623421/all/TOXIC_MULTINODULAR_GOITER_AND_TOXIC_ADENOMA. Accessed April 21, 2019.
TOXIC MULTINODULAR GOITER AND TOXIC ADENOMA. (2017). In Loscalzo, J., Jameson, J. L., Longo, D. L., Hauser, S. L., Fauci, A. S., & Kasper, D. L. (Eds.), Harrison's Manual of Medicine. Available from https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623421/all/TOXIC_MULTINODULAR_GOITER_AND_TOXIC_ADENOMA
TOXIC MULTINODULAR GOITER and TOXIC ADENOMA [Internet]. In: Loscalzo J, Jameson JL, Longo DL, Hauser SL, Fauci AS, Kasper DL, editors. Harrison's Manual of Medicine. McGraw Hill Inc.; 2017. [cited 2019 April 21]. Available from: https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623421/all/TOXIC_MULTINODULAR_GOITER_AND_TOXIC_ADENOMA.
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TY - ELEC T1 - TOXIC MULTINODULAR GOITER AND TOXIC ADENOMA ID - 623421 ED - Loscalzo,Joseph, ED - Jameson,J Larry, ED - Longo,Dan L, ED - Hauser,Stephen L, ED - Fauci,Anthony S, ED - Kasper,Dennis L, BT - Harrison's Manual of Medicine UR - https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623421/all/TOXIC_MULTINODULAR_GOITER_AND_TOXIC_ADENOMA PB - McGraw Hill Inc. ET - 19 DB - Harrison's Manual of Medicine DP - Unbound Medicine ER -