About Plummer's Disease

Plummer's disease is another name for toxic multinodular goiter or toxic adenoma. The thyroid gland contains nodules, or lumps, that produce thyroid hormone. When these nodules produce too much hormone, it is called hyperthyroidism. Plummer's disease is a form of hyperthyroidism. It increases your metabolism and causes several body systems to speed up. If not addressed and treated, the condition takes a physical toll on the body, including a quickening of the heartbeat, diarrhea, anxiety and weight loss.

Cause

Plummer's disease is a form of hyperthyroidism that is caused by an adenoma that separates itself from the rest of the thyroid gland, forming benign lumps that may release thyroxine and enlarge the thyroid. According to the Mayo Clinic, not all adenomas will make excess thyroxine, and physicians don't know what causes some to make too much of the hormone while others don't.

Symptoms

There are numerous symptoms that suggest a diagnosis of Plummer's disease, but it may be difficult to diagnose, because the symptoms are also common in other conditions. You may lose weight suddenly, even though you're eating normally. Your heartbeat may become rapid, you may sweat profusely and be nervous or anxious, you may experience heat sensitivity or you may have a hard time sleeping or be lethargic. Patients who take beta blockers such as propranolol for high blood pressure may not have these symptoms, because the drugs block epinephrine and norepinephrine from attaching to beta receptors on nerves, controlling heartbeat and anxiety.

Diagnosis

Your doctor will use your medical history, blood tests and a physical examination to diagnose Plummer's disease and hyperthyroidism. He will look for overactive reflexes, moist skin, eye changes and a tremor in your fingers. Blood tests will confirm the diagnosis if they show high levels of thyroxine and a limited amount, if any, of TSH. TSH is a hormone that sends a message to your thyroid gland to make more thyroxine.
A radioactive iodine uptake test can also be used to determine if you have hyperfunctioning nodules. In this test, the patient ingests a small amount of radioactive iodine, and then the doctor tests to see if the thyroid is working properly at intervals. A thyroid scan may also be used.

Complications

Plummer's disease and hyperthyroidism can lead to heart problems, including rapid heartbeat and congestive heart failure. This can be reversed under the right treatment. You may also experience eye problems, including bulging and red eyes; red and swollen skin; osteoporosis; and thyrotoxic crisis, which occurs when your symptoms suddenly worsen, leading to rapid pulse, fever and delirium.

Treatment

Your doctor will choose the best treatment plan for you, depending on your age and the condition of your thyroid. Some options include treatment with radioactive iodine, which is taken by mouth and absorbed by your thyroid gland. It causes the gland to become smaller and slows down thyroid activity. Beta blockers won't address your thyroid problem, but they can ease your heart palpitations and slow down your heartbeat. Anti-thyroid medications prevent your thyroid from making excess hormone, helping with the signs and symptoms of hyperthyroidism. You may need to take other medication to replace the production of thyroxine. Some patients may prefer surgery---removal of the diseased nodule---if they have a hard time tolerating the anti-thyroid drugs and don't want to undergo radioactive iodine therapy.