In 1913, Henry Plummer, an American physician was the first to describe<unk>  or Plummer's disease. In 1947, Cope, Rawson, and McArthur were the first who described the usage of radioactive iodine to demonstrate a "hot" thyroid nodule.Toxic multinodular<unk>  is classified into three types- Primary, secondary, tertiary hyperthyroidism.The progression to<unk>  usually involves the somatic gain-of-function mutations in the TSH receptor in autonomousl, toxic adenoma.The incidence of<unk>  is estimated to be 4.8 cases per 100,000 population per year. The prevalence of<unk>  is 100 cases per 100,000 population and accounts for 5% of all patients with hyperthyroidism.<unk>  commonly affects individuals older than 60 years of age. The frequency of<unk>  increases with age. Females are more commonly affected by<unk>  than men. Common risk factors in the development of multinodular<unk>  include female sex,age over 50 years,areas with decreased iodine intake, iodine supplementation, natural<unk> ogens, vitamin A and iron deficiency,selenium deficiency.Toxic multinodular<unk>  is diagnosed with a physical examination which shows nodules in the throat and rapid heart rate, among other signs such as diaphoresis and tremors. Blood screening includes tests for elevated T3 and T4 hormone levels that indicate hyperthyroidism. TSH assays are the best initial screening tool for hyperthyroidism.If left untreated,<unk>  may progress to develop hyperthyroidism. However, the progression of<unk>  is quite slow. Untreated patients initially have a history of thyroid enlargement followed by a long period of subclinical hyperthyroidism. Overt hyperthyroidism occurs late in the course of<unk> . Common complications of<unk>  include tachycardia, arrhythmia, atrial fibrillation, heart failure (dilated cardiomyopathy), pulmonary hypertension, facial plethora, inspiratory stridor, hoarseness, dysphagia, bone mineral loss and thyroid storm. Prognosis of<unk>  is generally good with treatment. Both surgery and radioactive iodine therapy can confer a moderate long-term risk of hypothyroidism and such patients require lifelong hormone replacement therapy.<unk>  is commonly seen in elderly. The majority of patients with<unk>  are asymptomatic. However, they can present with symptoms such as swelling or pain in front of the neck, cough, shortness of breath, hoarseness, Diaphoresis, skin flushing, increased appetite, restlessness, nervousness, [[[heat intolerance]], tremors, palpitations, insomnia, anxiety, menstrual irregularities. Diagnosis of multinodular<unk>  is made by measurement of serum thyroid-stimulating hormone (TSH) , serum Free T4 test , total thyroxine (T4) and free triiodothyronine (T3).An ECG may be helpful in the diagnosis of hyperthyroidism due to<unk> . Findings on an ECG suggestive of hyperthyroidism due to include sinus tachycardia, higher voltage of P and T waves, elevated amplitude of QRS complex, prolonged P-Q and shortened Q-T intervals. Findings on an x-ray suggestive of multinodular<unk>  include anterior/superior mediastinal mass, that may be associated with deviation of the trachea and/or cervicothoracic sign.CT scan may be helpful in the diagnosis and fully characterizing the extent of substernal<unk> e. Findings on CT scan suggestive of multinodular<unk>  include enlarged and heterogeneous thyroid gland. CT scan is useful in defining the extent of tracheal deviation and compression.CT scan–guided fine needle aspiration biopsy(FNAB) may be helpful. MRI may be helpful in the assessment of extent of substernal<unk> s. Findings on MRI suggestive of multinodular<unk>  include enlarged and heterogeneous thyroid gland. Thyroid ultrasonography is the imaging method of choice in the diagnosis of multinodular<unk> . Findings on an ultrasonography suggestive of multinodular<unk>  include more than one nodule including the non-palpable nodules cysts with varying echogenicity. Thyroid ultrasonography helps in assessment of size and number of nodules. Assessment of vascular characteristics of a thyroid nodule with Doppler helps in screening thyroid nodules for malignancy. Radioidodine uptake may be helpful in the diagnosis of multinodular<unk> . The mainstay of treatment for<unk>  is Surgery. Patients with symptomatic hyperthyroidism, sub-clinical hyperthyroid patients with expected compilations and patients refusing surgical therapy are treated with beta blockers and anti-thyroid pharmacological groups. Surgery is the mainstay of treatment for<unk> . Usually, subtotal thyroidectomy is performed but unilateral thyroid lobectomy can also be performed in selected cases. Effective measures for the primary prevention of<unk>  include mainly the adequate iodine intake, smoking cessation and also by maintaining normal intake of iron and vitamin A.
Toxic multinodular goiter
Thyroid adenoma
Toxic multinodular goitre
Silent thyroiditis
Follicular thyroid cancer
Nodular thyroid disease
Postpartum thyroiditis
Papillary thyroid cancer