What Is Plummer Disease?

Toxic Multinodular Goiter

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Plummer disease is a condition that causes hyperthyroidism (overactive thyroid). With Plummer disease, nodules in the thyroid gland produce excess thyroid hormones. This condition also is known as toxic multinodular goiter.

One or more nodules on the thyroid that overproduce thyroid hormones can cause hyperthyroidism. If the condition involves multiple nodules, it is called multinodular. With Plummer disease, there may be several nodules, but not all produce thyroid hormone. It’s the second-most common cause of hyperthyroidism.

This article will discuss Plummer disease symptoms, causes, diagnosis, treatment, and prognosis. 

Person being examined by healthcare provider for Plummer's disease

mixetto / Getty Images

Plummer Disease Symptoms

The main symptoms of Plummer disease are the same as those of hyperthyroidism. Too much thyroid hormone can cause:

  • Diarrhea
  • Fatigue
  • Increased appetite
  • Weight loss
  • Trouble sleeping
  • Flushing
  • Rapid heart rate or palpitations
  • Increased sweating
  • Heat intolerance

This condition causes goiter, which is an enlargement of the thyroid gland that can result in a prominent neck bulge). However, the enlargement may not be noticeable at first.

People with Plummer disease may also experience:

  • Irregular menstruation
  • Restlessness
  • Muscle cramping
  • Mood changes

Causes

Experts believe that toxic multinodular goiter may have a genetic link. If you have a family history of this condition, you’re more likely to develop it. Females are also more likely to develop toxic nodules compared to males.

Other potential risk factors include:

  • Being a smoker
  • Being female
  • Being over 55

What Else Causes Hyperthyroidism?

Your healthcare provider may recommend additional tests to determine the cause of hyperthyroidism, even if a blood test confirms overactive thyroid.

Other possible causes include:

  • Graves' disease: An autoimmune condition in which the immune system produces antibodies that result in increased thyroid hormone production
  • Thyroiditis: Inflammation of the thyroid gland
  • Pituitary gland tumors
  • Taking too much thyroid medication
  • Too much iodine

Diagnosis

A healthcare provider may suspect you have hyperthyroidism based on your symptoms and physical exam. They will order lab testing to confirm the diagnosis to check your thyroid hormone levels. 

You may have hyperthyroidism if lab tests show low thyroid stimulating hormone (TSH) levels and high triiodothyronine (T3) and thyroxine (T4).

If your tests show hyperthyroidism, the healthcare provider will likely order imaging tests to examine the thyroid. The presence of one or more nodules may indicate toxic multinodular goiter.

A healthcare provider will usually order a fine needle aspiration biopsy to determine whether the nodules are toxic. This procedure can be done in a healthcare provider's office. A thin needle is used to draw out the contents of a nodule. It is then sent to the laboratory for analysis.

Treatment

Treatment for toxic multinodular goiter may involve medication therapy and surgery. Medication can help control hyperthyroid symptoms but doesn't address the underlying issue of nodules overproducing thyroid hormones. 

One option is radioactive iodine therapy to shrink the toxic nodules. A radioactive form (isotope) of iodine is given in pill form. The thyroid gland absorbs most of the iodine in the body and doesn't distinguish between isotopes. Radioactivity kills thyroid cells. You may need two rounds of iodine therapy if you have a large goiter due to toxic nodules.

A healthcare provider may recommend surgical removal if the toxic nodules are too large to treat with radioactive iodine therapy. Surgery involves removing a large chunk of the thyroid containing nodules.

There may be enough thyroid tissue left over to produce the right level of hormones. Medication may still be necessary, especially if the surgeon must remove the entire thyroid.

Prognosis

Some people with Plummer disease do not have symptoms and may not need treatment. For people with symptoms, treatment is usually effective. In most cases, there is no recurrence of the disease after thyroid surgery.

However, it should be noted that the disease tends to affect older adults. And in older age, people may be more likely to experience complications.

Research from 2021 and 2022 also suggests that having a condition that causes hyperthyroidism, like toxic multinodular goiter, may come with a higher risk of developing thyroid cancer.

Summary 

Plummer disease is a condition in which nodules on the thyroid gland produce too much thyroid hormone, which causes hyperthyroidism. People with Plummer disease can have one or more nodules on the thyroid.

A neck bulge (goiter) and signs of excess thyroid hormone such as a rapid heart rate and weight loss are possible symptoms, but you may not have obvious symptoms. A healthcare provider will order blood tests if there are symptoms. If tests show you have hyperthyroidism, they will use imaging to take a closer look at the thyroid. 

Nodules may mean you have Plummer disease, and a biopsy will confirm the diagnosis. Treatment options include medication, radioactive iodine therapy, and surgery. You may need replacement thyroid hormone after surgical treatment. 

A Word From Verywell 

If you have a neck bulge or are experiencing symptoms of hyperthyroidism, see a healthcare provider. They can order blood tests to confirm the diagnosis or check for other underlying conditions that may be causing symptoms like fatigue, rapid heart rate, and weight loss.

Because symptoms of hyperthyroidism can be vague and mimic those of other conditions, it may take time to get a diagnosis. But don’t give up. Let your provider know of all your symptoms to get an accurate evaluation and treatment.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Penn Medicine. Toxic nodular goiter.

  2. National Institute of Diabetes and Digestive Kidney Disease. Hyperthyroidism (overactive thyroid).

  3. American Thyroid Association. Toxic nodule and toxic multinodular goiter.

  4. Lin YS, Wu HY, Yu MC, et al. Patient outcomes following surgical management of multinodular goiter. Medicine (Baltimore). 2016;95(28):e194. doi:10.1097/MD.0000000000004194

  5. Apostolou K, Zivaljevic V, Tausanovic K, et al. Prevalence and risk factors for thyroid cancer in patients with multinodular goiter. BJS Open. 2021;5(1):zra014. doi:10.1093/bjsopen/zraa014

  6. Mohamed TZ, Sultan AAEA, Tag El-Din M, et al. Incidence and risk factors of thyroid malignancy in patients with toxic nodular goiter. Int J Surg Oncol. 2022;2022:1054297. doi:10.1155/2022/1054297

By Steph Coelho
Steph Coelho is a freelance health writer, web producer, and editor based in Montreal. She specializes in covering general wellness and chronic illness.