Complications
Risk is low with an experienced surgeon.
Risk is low with an experienced surgeon.
Hypocalcemia may be transient or permanent.
Hyperthyroidism, overt or subclinical (i.e., reduced serum thyroid stimulating hormone [TSH] concentration but free thyroxine levels within reference ranges) is associated with increased risk of atrial fibrillation.[31]
More common in older patients with toxic multinodular goiter than in people with single toxic nodules.
People aged >60 years with untreated subclinical hyperthyroidism are about 3 times more likely to develop cardiac dysfunction, including atrial fibrillation, over 10 years than are euthyroid people.[44] The risk of systemic embolism is unknown.
Risk of hypothyroidism may not be related to the dose of radioactive iodine.[39][40][41][60]
Patients are more likely to become hypothyroid if they have underlying autoimmune thyroiditis or have initially incomplete suppression of extranodular tissue.[56]
In a 20-year retrospective study, 60% of patients treated with I-131 for a toxic adenoma eventually became hypothyroid. Pretreatment with methimazole increased risk for hypothyroidism. However, the effects of methimazole seemed to depend on the baseline degree of suppression of extranodular thyroid parenchyma.[57]
In one meta-analysis, the overall risk of hypothyroidism after hemithyroidectomy was 22%.[61] Patients need lifelong annual monitoring for the development of hypothyroidism after surgery for toxic adenoma.
Can occur with large nodules.
Gastrointestinal, cardiac, local or pulmonary causes should be sought for symptoms such as choking, dysphagia or hoarseness.[21]
Iodinated contrast computed tomography (CT) scans should be avoided in evaluation of goiters, because of risk of iodine-induced hyperthyroidism (Jod-Basedow effect).
Rare severe, life-threatening condition that can occur after an illness in patients with hyperthyroidism. Patients may present with weakness, severe tachycardia and fever.[59] Treatment includes beta-blockers, antithyroid drugs, supportive care, and corticosteroids; an endocrine specialist should be consulted.
Rare, but may be idiosyncratic.
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