Toxic multinodular goiter risk factors

Common risk factors in the development of multinodular goiter include female sex, age over 50 years, areas with decreased iodine intake, iodine supplementation, natural goitrogens, vitamin A deficiency, iron deficiency and selenium deficiency.

• Common risk factors in the development of multinodular goiter include:
  • Female sex
  • Age over 50 years
  • Smoking^[1]
  • Areas with decreased iodine intake^[2]
• Natural goitrogens associated with the development of multinodular goiter include:^[3]
  • Millet, soy beans, coconut, babassu contain flavonoids that impair thyroperoxidase enzyme.
  • Cassava, sweet potato, sorghum contain cyanogenic glucosides metabolized to thiocyanates that inhibits thyroid iodine uptake.
  • Cabbage, cauliflower, broccoli, turnips contain glucosinolates that impair thyroid iodine uptake.
  • Seaweed (kelp) contains excess iodine that inhibits release of thyroid hormones.
• Vitamin A and iron deficiency increases TSH stimulation and reduces heme-dependent thyroperoxidase activity.
• Selenium deficiency accumulates peroxidase and causes deiodinase deficiency resulting in impaired thyroid hormone synthesis.
• Head or neck irradiation in an adult is associated with increased frequency of toxic nodular goiter.
• Iodine supplementation or iodinated contrast agents or iodinated drugs, such as amiodarone, may also induce hyperthyroidism in patients with underlying nontoxic multinodular goiter (Jod-Basedow effect).^[4]

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