toxic multinodular goiter (Plummer's disease)

Epidemiology

• most common cause of hyperthyroidism in the elderly
• it occurs in <1/2 of patients with multinodular goiter

Clinical manifestations

• thyroid nodules & thyroid asymmetry
• cardiovascular manifestations tend to predominate
• differs from Grave's disease clinically:
  • no associated ophthalmopathy
  • no associated dermopathy
  • hypermetabolism is less severe

Management

• beta-blockers:
  • decrease beta-adrenergic mediated effects of thyrotoxicosis
  • decrease peripheral conversion of T4 to T3
  • indicated for all forms of thyrotoxicosis
  • titrate according to heart rate
  • propranolol 20-40 mg PO QID
• radioactive I-131 ablation
• subtotal thyroidectomy may be treatment of choice

More general terms

• multinodular goiter

Additional terms

• hot nodule; toxic thyroid adenoma
• hyperthyroidism