Search
toxic multinodular goiter (Plummer's disease)
Epidemiology:
1) most common cause of hyperthyroidism in the elderly
2) it occurs in <1/2 of patients with multinodular goiter
Clinical manifestations:
1) thyroid nodules & thyroid asymmetry
2) cardiovascular manifestations tend to predominate
3) differs from Grave's disease clinically:
a) no associated ophthalmopathy
b) no associated dermopathy
c) hypermetabolism is less severe
Management:
1) beta-blockers:
a) decrease beta-adrenergic mediated effects of thyrotoxicosis
b) decrease peripheral conversion of T4 to T3
c) indicated for all forms of thyrotoxicosis
d) titrate according to heart rate
e) propranolol 20-40 mg PO QID
2) radioactive I-131 ablation
3) subtotal thyroidectomy may be treatment of choice [2]
Related
hot nodule; toxic thyroid adenoma
hyperthyroidism
General
multinodular goiter
References
- Manual of Medical Therapeutics, 28th ed, Ewald &
McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 469
- Solomon DH, in: UCLA Intensive Course in Geriatric Medicine &
Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- Siegel RD, Lee SL
Toxic nodular goiter. Toxic adenoma and toxic multinodular
goiter.
Endocrinol Metab Clin North Am. 1998 Mar;27(1):151-68. Review.
PMID: 9534034