Plummer’s disease Symptoms, Causes, Diagnosis, Treatment

Plummer’s disease, a condition of hyperthyroidism. Hyperthyroidism is the enlargement of the thyroid gland (goiter) in the midline of the neck due to the formation of small, firm, rounded nodular masses that may produce too much or too little thyroid hormone.

What is Plummer’s disease?

Plummer’s disease, a condition of hyperthyroidism, resulting in nodular goiter. It has similarities with other thyroid gland diseases. Graves disease with hyperthyroidism, associated with nodules due to iodine deficiency. But symptoms like bulging eyeballs are not signs of Plummer’s disease, which is observed in Graves disease. It is named TNG (toxic nodular goiter) because hyperthyroidism is involved with nodular goiter. Common in females above 60 years old is more prone to it. And it is never reported in children. In thyroid nodules, the chances of malignancies are less commonly reported. Practically, patients with multinodular toxic goiter are at high risk of rare thyrotoxicosis, which may be induced due to iodine. 

Plummer's disease Symptoms, Causes, Diagnosis, Treatment

Plummer’s disease Symptoms

The sign and symptoms depend on the patient’s age and the severity of the disease. Most hyperthyroidism symptoms are seen in Plummer’s disease, but Protruding of the eyes is not present. Symptoms of Plummer’s disease can be seen in other organ systems as well. In the heart, Common symptoms are tachycardia, palpitations, chest pain. Nervousness, heat intolerance, fatigue, insomnia, restlessness, anxiety, increased sweating, weight loss, increased appetite, changes in memory, and mood are psychological disturbance symptoms produced due to hormonal imbalance. Other symptoms are non-painful goiter or disfigurement of the neck, frequent bowel movements, an irregular menstrual period in women, extremity tremor, and muscle cramps. In patients over 70, atrial fibrillation and anorexia are more common. 50% of patients experience breathing and swallowing difficulty due to obstruction caused by the swelled thyroid gland.

Plummer’s disease Causes

Nodular masses in the thyroid glands may develop when a person has a simple goiter for many years. When a person takes large doses of iodine as a medication for iodine deficiency or as a dye in a CT scan, the chances of Plummer’s diseases might increase. A patient with a family history of toxic goiter nodules is more at risk. Women with age between 35 to 50 have chances, but over 50 are more affected. Certain thyroid inflammation types are less frequent causes of Plummer’s disease, including painless thyroiditis and subacute thyroiditis. Sometimes medicines like amiodarone, lithium, or diseases like choriocarcinoma and pregnancy conditions are responsible for more iodine secretion.

Plummer’s disease Diagnosis

Laboratory findings in which associated hormone levels are tested to check these hormones’ functioning either the elevated serum TSH, suppressed triiodothyronine (T3), and thyroxine (T4). Thyroid ultrasound, computed tomography (CT), and magnetic resonance imaging(MRI) are not routinely performed even though Image testing helps diagnose one or more nodules in the neck. Nodules may be palpable and can be felt by the physician’s hand. Radiological investigations of the nodules are done through sonography. Urinary iodine excretion is tested in case of iodine excess. The biopsy is performed in case of neoplasm in thyroid masses.

Plummer’s disease Treatment

Management and treatment of the disease depend on the condition of the disease. First, a patient shouldn’t ignore the state of the simple goiter or hyperthyroidism. Must visit the endocrinologist or physician if he observes some unusual signs and symptoms in his body. The patient should also be careful while taking iodine supplements and discussing it with his doctor before using them. Antithyroid drugs that are propylthiouracil, methimazole are the first-line treatment in Plummer’s disease patients with mild hyperthyroidism. Anti thyroid drugs are used along with beta-blockers because beta-blockers tend to control hyperthyroidism symptoms until the body’s thyroid hormone level get normalized. Long-term anti thyroid drug therapy is not recommended except in a few cases, like in patients from the senior age group with concomitant diseases.

Other treatment options are thyroid surgery and radioiodine therapy depends on the body’s concentration of thyroid hormone. In thyroid surgery, all or part of the thyroid gland is removed. It is considered with severe hyperthyroidism, which gives rapid relief from the pain, nodular tissue got removed, which leads to permanent resolution from the disease. But before going to surgery, the risk versus benefits ratio must determine. In the case of large goiters with suspicion of malignancy, thyroid surgery is the treatment of choice. After surgery, oral calcium should be prescribed along with serum calcium monitoring for potential hypothyroidism. It is observed that calcium balance got disturbed in hypothyroidism. Thyroid hormone replacement such as serum TSH and free thyroxine should be prescribed in those patients who went under surgical removal of the whole or part of the thyroid gland. To reduce the goiter’s nodular size, radioiodine therapy is beneficial, especially in outpatients with multinodular goiter, due to its individually designed doses. In this therapy, radioactive iodine is given by mouth.

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