Toxic Nodular Goiter or Plummer's Disease

Plummer's Disease

Toxic Nodular Goiter (or Plummer's Disease is the other name for a toxic nodular goiter) is less common than Graves' disease, and prevalence are increases with age and in the presence of iodine deficiency. Disease is usually progresses. With toxic nodular goiter the medical therapy is not as helpful as with Graves' disease.

Once the diagnosis has been made, the treating physician and patient should discuss each of the treatment options, including the logistics, benefits, expected speed of recovery, drawbacks, side effects, and costs.

Patients with toxic multinodular nodular goiter or toxic solitary nodule is better to be treated with either I-131 therapy or thyroidectomy (per recent ATA Guidelines), but in some occasions, long-term, low-dose treatment with Methimazole may be appropriate.

ATA Guidelines RECOMMENDATION 41 stated that the surgery for toxic multinodular nodular goiter should be performed by a high-volume thyroid surgeon.

The benefits of the surgery would include a quick recovery from the disease, absence of toxic effect from medical therapy or radioactive iodine therapy. The downside to surgical therapy would include small, 1% in a hands of experience surgeon, rate of complications and presence of a small scar. These would include 1% rate of hoarseness (injury to the vocal cords nerve), 1% low calcium level, and 0.5% rate of bleeding or infection. In hands of the experience thyroid surgeon those side effects is minimal and scar is very small, as opposite to low volume surgeon when complication rate could be approaching 10%.


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