Surgery for Toxic Goiter - Khobragade Multispeciality Hospital

What is Toxic Goiter?

Toxic goiter, also known as toxic nodular goiter or toxic multinodular goiter, is a condition where there is an enlarged thyroid gland with overactive nodules producing excess thyroid hormones (hyperthyroidism). It commonly develops in individuals with a long-standing simple goiter. The condition leads to increased metabolism and symptoms of hyperthyroidism.

Surgery for toxic goiter is a safe and effective treatment option for patients with large goiters, compressive symptoms, or when other treatments are unsuitable. Consultation with an experienced endocrinologist and thyroid surgeon is essential to determine the best treatment plan tailored to individual health needs.

Symptoms of Toxic Goiter

People with toxic goiter may experience:

Unexplained weight loss despite good appetite
Rapid or irregular heartbeat (palpitations)
Nervousness, anxiety, or irritability
Tremors in hands or fingers
Increased sweating and heat intolerance
Difficulty sleeping
Muscle weakness
Enlarged thyroid gland visible in the neck
Shortness of breath (due to large goiter compressing nearby structures)
Difficulty swallowing (if the goiter is large)

Procedure or Treatment for Toxic Goiter

Treatment options include:

1. Medications

Antithyroid drugs (e.g. Methimazole, Propylthiouracil) to reduce hormone production.
Beta-blockers to control symptoms like rapid heartbeat.

However, medications may not provide a permanent cure, especially in toxic nodular goiter.

2. Radioactive Iodine Therapy

Involves oral intake of radioactive iodine that destroys overactive thyroid tissue gradually.
Suitable for many patients but not recommended during pregnancy or severe compression symptoms.

3. Surgery (Thyroidectomy)

Surgery is often preferred when:

The goiter is large and causing compression symptoms (difficulty breathing or swallowing).
There is suspicion of cancer.
The patient prefers definitive treatment avoiding radioactive iodine.
Antithyroid drugs are ineffective or not tolerated.

Procedure

Subtotal thyroidectomy: Partial removal of the thyroid gland.
Total thyroidectomy: Complete removal of the thyroid gland, often preferred to reduce recurrence.

The surgery is done under general anaesthesia, involving an incision in the lower neck to remove the affected thyroid tissue. Hospital stay is generally 1-2 days with full recovery in a few weeks.

Prevention of Toxic Goiter

Adequate iodine intake through diet or iodised salt to prevent simple goiter progressing to toxic goiter.
Regular thyroid check-ups if you have a history of goiter.
Prompt treatment of existing thyroid nodules to monitor their activity.

Benefits of Surgery for Toxic Goiter

Permanent cure for hyperthyroidism caused by toxic goiter
Relief from compression symptoms like difficulty in swallowing or breathing
Eliminates the risk of malignant transformation within nodules
Improves quality of life by stabilising thyroid hormone levels after appropriate replacement therapy if needed post-surgery

Types of Toxic Goiter

Toxic Multinodular Goiter (Plummer’s disease): Multiple nodules in the thyroid producing excess hormones.
Toxic Adenoma: Single overactive nodule in the thyroid gland.
Diffuse Toxic Goiter (Graves’ disease): Entire thyroid is overactive (though it differs in pathology, surgery approach is similar if needed).