Plummer's Disease: An Overview

Overview

Plummer's disease is also known as a toxic multinodular goiter or MNG. A goiter is a growth of nodules in your thyroid or the entire gland. The thyroid gland is located just below your Adam's apple.

Plummer's disease is a common cause of hyperthyroidism, a condition in which the thyroid becomes overactive and produces more hormones than usual. 

Since these hormones are essential to control how your body uses energy, this disease can have many detrimental effects on your health. There are several ways to manage Plummer's disease, including medication and surgical procedures. Treatment may not be required when symptoms are less apparent and more manageable. 

What is Plummer's disease?

Plummer's disease is the growth of a multinodular goiter on the thyroid gland. The growth itself produces hormones. When more thyroid hormones are produced, many systems in the body can speed up as a result. 

This can affect the heartbeat, sweat glands, heat tolerance, and other bodily functions. The result is hyperthyroidism, which can range in severity from subclinical (less severe) to severe thyrotoxicosis. 

Etiology

The etiology of a disease is its cause or origin. Although its etiology is still unclear, it is known that Plummer's disease has a genetic component. Also, it may be associated with smoking, stress, and thyroid-stimulating hormone levels. 

A goiter may be present on the thyroid for many years before it fully develops into Plummer's disease, usually in old age. Some factors that may contribute to this shift include:

• Consuming medication containing iodine

• Going from iodine deficiency to higher levels of iodine consumption

• Receiving iodine through a vein (This commonly occurs when receiving a CT scan or heart catheterization.) 

Epidemiology

Epidemiology studies how often a disease is found in a population and why it occurs. It detects patterns and can help people understand the way diseases are spread. The epidemiology of Plummer's disease and hyperthyroidism are closely linked.

Goiters are found in around 5% of the US population. However, they are not always related to Plummer’s disease.¹ 

Plummer's disease is one of the leading causes of hyperthyroidism, second to Graves’ disease. It is common in women and people over 50. It is rare in children. 

The harsh effects of Plummer's disease, such as a thyrotoxicosis crisis, often become more apparent after having a goiter for a long time and are more common in people with a family history of the disease.  

Pathophysiology

Pathophysiology is the study of the changes that occur in the body as a result of a disease. Plummer's disease causes some nodules in the thyroid gland to produce hormones independently and hyperactively. It can also cause some areas of the thyroid to be suppressed. 

“Hyperactively” means the nodules produce more hormones than usual. This causes the normal regulatory functions of the thyroid to become compromised as the body can no longer control the number of hormones produced. 

The thyroid contributes to many processes and produces hormones that spread all over the body. This can result in many different symptoms of the disease. 

Symptoms

Symptoms of Plummer's disease could include one or more of the following:

• Weight loss

• Excessive tiredness

• Increase in sweat

• Tremors

• Nervousness

• Muscle cramps

• Heat intolerance

• Hunger

• Irregularity of menstrual period

• Increase in bowel movements

If you are an older adult, you may experience less specific symptoms, such as:

• Fatigue

• Weakness

• Chest palpitations, pressure, or pain

• Changes in mood or memory

If a neck mass is present due to the disease, you may experience:

• Swallowing difficulties

• Hoarse voice

• Shortness of breath

• Compression of the trachea

It is important to note that patients with Plummer's disease have fewer symptoms than those with Graves’ disease (another cause of hyperthyroidism). For example, people with Plummer’s disease don’t have bulging eyes as a symptom.

Diagnosis

Your doctor will conduct a physical exam and other tests to determine if you have Plummer's disease. They will check for an enlarged thyroid or a mass on the thyroid and can also listen to your heart rate. 

Other tests may include an ultrasound of your thyroid, scanning for radioactive iodine uptake, or blood tests to determine thyroid hormone levels. 

Treatment

If the disease is only causing subclinical hyperthyroidism, it is often unnecessary to treat, as the symptoms are not very severe or noticeable. It is advised to avoid using supplements or medication with high levels of iodine in them.

Some patients are at higher risk of detrimental effects and should be treated in the subclinical phase. These include:

• Patients with osteoporosis

• Women with osteopenia

• Patients at risk of developing atrial fibrillation or with atrial fibrillation

Treatment for Plummer's disease in advanced stages can include:

• Surgery to remove the thyroid

• Radioiodine therapy, taken in an oral capsule form

• Beta-blocker medications to control symptoms

• Medications that block the absorption of iodine

• Medications that change how the body uses iodine

Possible complications

Possible complications if the disease is allowed to progress include:

• Decrease in bone density (osteoporosis)

• Heart failure

• Irregular or fast heartbeat

• Thyrotoxicosis crisis 

A thyrotoxicosis crisis involves a rapid increase in symptoms, including abdominal pain, decreased alertness, and fever, requiring immediate hospitalization. 

Prognosis

The prognosis for Plummer's disease is encouraging. Many cases don’t even need treatment, and in those that require surgery, the likelihood of future recurrence is low. Because this disease is common in older adults, other health factors can sometimes affect outcomes. However, it is usually treatable, and the symptoms are manageable.

The lowdown

Plummer's disease is a treatable condition that can cause hyperthyroidism with variable severity. This is due to excessive hormone production related to the growth of the nodules on your thyroid gland. It is more common in older adults and women. Contact your local health professional if you have experienced any symptoms listed in this article.  

An early diagnosis can help prevent it from progressing to a more damaging thyroid condition such as thyrotoxicosis. Many symptoms will decrease with appropriate treatment, and your prognosis is highly likely to be positive. 

Frequently asked questions:

Is Plummer's disease curable?

Plummer's disease is treatable with numerous medications and procedures that can manage or eliminate symptoms. In some cases, this disease does not require treatment and can be managed by simply avoiding iodine in your diet. Older adults may struggle more if the effects of the disease take a toll on the heart — their prognosis is less definitive.

What is the difference between Graves’ disease and Plummer's disease?

Graves’ disease often produces more pronounced and severe symptoms than Plummer's disease. Graves’ disease is an autoimmune condition in which the thyroid is overactive rather than caused by a goiter. 

Is Plummer's disease hereditary?

Possibly, genetic factors contribute to the development of Plummer's disease, as those with a family history of the disease more commonly develop it than those who don’t. Nevertheless, having a family member with Plummer's disease does not guarantee you will also develop it.