ABSTRACT
Introduction: Toxic multinodular goitre, first described by H.S.
Plummer in 1913, is unremitting and often develops slowly, with more subtle
symptoms than Graves’ disease. Cardiac symptoms such as tachycardia, heart
failure, or arrhythmia and atrial fibrillation are most frequent. Here we
describe a case who presented with symptoms of thyroid enlargement and heart
failure. Case report: A 48-year old female presented to us with
complaints of dysphagia, hoarseness of voice, breathlessness on exertion and
palpitations since one month ago. Furthermore, the patient gave history of
swelling of the neck which was initially pea sized and gradually increased to
the current size over a period of two months. On examining the swelling of the
neck, thyroid gland appears enlarged, firm with multiple nodules. Two-dimensional
echocardiography revealed a dilated left ventricle with generalized
hypokinesia. Computed Tomography of the neck suggested enlarged thyroid gland
(12.1 cm × 6.5 cm) with heterogenous architecture, and thyroid
gland encircling the trachea for approximately 270 degree with mass effect.
Thyroid scan showed multinodular goitre with multiple hyperfunctioning nodules
of both lobes and warm nodules only in left lobe. The patient was diagnosed as
multinodular goitre with cardiomyopathy. The patient was treated medically with
methimazole, propranolol, aspirin, ramipril, sustained release urodeoxycholic
acid, rosuvastatin, pantoprazole and multivitamin. The patient underwent near
total thyroidectomy with radioactive iodine ablation, as and when required. Conclusion: Patients with toxic multinodular goitre very frequently present with
cardiovascular symptoms, which when identified and treated early can reduce the
morbidity significantly.