Toxic Nodular Goiter or 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%.
Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA, Ross DS, Sosa JA, Stan MN; American Thyroid Association; American Association of Clinical Endocrinologists.Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pract. 2011 May-Jun;17(3):456-520.
Stavrakis A, et al VA System, Los Angeles, Surgeon volume as a predictor of outcomes in inpatient and outpatient endocrine surgery” Surgery. 2007 12;142(6)
Sosa JA, Udelsman R et al. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg. 9,228(3), 1998.
Pieracci FM, Fahey TJ, Cornell Univ, Effect of hospital volume of thyroidectomies on outcomes following substernal thyroidectomy. World J Surg, 5,32(5), 2008