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Plummer’s disease

GC: n

S: MD - http://emedicine.medscape.com/article/120497-overview(external link) (last access: 7 May 2017); NCBI - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3618840/(external link) (last access: 20 March 2018).

N: 1. - Plummer (pn): Henry S. Plummer (1874-1936) was graduated M.D. from North-Western University in 1898. He practiced with his father in Racine, Minnesota, for a period before he joined the Mayo Clinic in 1901. He later became head of the internal department of the Mayo Clinic and professor at the Medical School of Minnesota.
- disease (n): Early 14c., from Old French desaise (‘discomfort, inconvenience’), des- (‘dis = without, away’) + -aise (‘ease = physical comfort, undisturbed state of the body; tranquility, peace of mind’).
2. Plummer’s disease is a hyperthyroidism with a nodular oiter due to Plummer’s adenoma. Prevalent in females; onset after 40 years of age.
3. This disease also called toxic nodular goiter.
4. Epidemiology:
  • Frequency: United States – Toxic nodular goiter accounts for approximately 15-30% of cases of hyperthyroidism in the United States, second only to Graves disease.
  • International: In areas of endemic iodine deficiency, toxic nodular goiter (TNG) accounts for approximately 58% of cases of hyperthyroidism, 10% of which are from solitary toxic nodules. Graves disease accounts for 40% of cases of hyperthyroidism. In patients with underlying nontoxic multinodular goiter, initial iodine supplementation (or iodinated contrast agents) can lead to hyperthyroidism (Jod-Basedow effect) Iodinated drugs, such as amiodarone, may also induce hyperthyroidism in patients with underlying nontoxic multinodular goiter. Roughly 3% of patients treated with amiodarone in the United States (more in areas of iodine deficiency) develop amiodarone-induced hyperthyroidism.
  • Mortality/Morbidity: Morbidity and mortality from toxic nodular goiter (TNG) may be divided into problems related to hyperthyroidism and problems related to growth of the nodules and gland. Local compression problems due to nodule growth, although unusual, include dyspnea, hoarseness, and dysphagia. Both TNG and Graves disease have increased mortality but for different reasons. TNG is more common in elderly adults; therefore, complications due to comorbidities, such as coronary artery disease, are significant in the management of hyperthyroidism.
  • Sex: Toxic nodular goiter occurs more commonly in women than in men. In women and men older than 40 years, the prevalence rate of palpable nodules is 5-7% and 1-2%, respectively.
  • Age: Most patients with toxic nodular goiter (TNG) are older than 50 years.
5. Methods: The presentation, operative treatment, pathology, and clinical course of 362 consecutive patients treated at our institution for Plummer’s disease from 1990 to 1999 were retrospectively reviewed.
Results: Three hundred forty-six patients (63 men and 283 women) were treated surgically (181, 53%), with radioiodine (RAI, 157, 45%), or a combination of both (8, 2%) Mean age was 62 years (surgical, 55 years; RAI, 69 years) Nearly half were symptomatic, 51 (15%) with airway or swallowing compromise and 110 (32%) with cardiac complications. The estimated goiter size was larger (60 g or greater) in surgical (72 patients, 38%) than medically treated (45 patients, 29%) patients. RAI treatment dose averaged 28 mCi; 10 patients (6%) required a second treatment, and 8 patients failed treatment and required subsequent thyroidectomy. Types of thyroidectomy included total (29 patients, 16%), near-total (47 patients, 26%), bilateral subtotal (46 patients, 25%), and unilateral (58 patients, 32%) One month after treatment, hyperthyroidism had resolved in 96% of the surgical patients but only 6% of the RAI patients (mean time to resolution, 5.4 months) Only 55 (38%) of the RAI patients’ goiters reduced in size. Recurrent laryngeal nerve paralysis and hypoparathyroidism each occurred in 3 (2%) patients.
Conclusions: Surgical treatment results in rapid, reliable resolution of hyperthyroidism and removal of the nodular goiter with low morbidity and no mortality. RAI is also safe and effective, usually requiring a single dose, but the results are delayed and it usually fails to resolve a goiter.
6. Cultural Interrelation: We could mention episode 3 Charity Case from the TV series (2004-2012) House M. D. (season 8).

S: 1. WNMDT – http://www.whonamedit.com/doctor.cfm/1074.html(external link) (last access: 16 May 2017); OED – http://www.etymonline.com/index.php?term=disease&allowed_in_frame=0(external link) (last access: 17 March 2017). 2. WNMDT – http://www.whonamedit.com/synd.cfm/1094.html(external link) (last access: 28 May 2017). 3. MEDICALDICT – http://medical-dictionary.thefreedictionary.com/Plummer%27s+disease(external link) (last access: 28 May 2017). 4. MD – http://emedicine.medscape.com/article/120497-overview#a6(external link) (last access: 28 May 2017). 5. NCBI – https://www.ncbi.nlm.nih.gov/pubmed/12490836(external link) (last access: 28 May 2017). 6. http://www.housemd-guide.com/season8/803charitycase.php(external link) (last access: 20 March 2018).

SYN: toxic nodular goiter.

S: MD - http://emedicine.medscape.com/article/120497-overview(external link) (last access: 7 May 2017)

CR: thyroid gland


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