PLUMMER'S DISEASE

also called toxic multinodular goitre thyroid condition characterized by marked enlargement of the thyroid gland (goitre), firm thyroid nodules, and mild overproduction of thyroid hormone (hyperthyroidism). Plummer's disease, which usually occurs in older people, is of unknown etiology. Its symptoms resemble those of Graves' disease (q.v.), a condition believed to be an autoimmune disorder caused by antibodies to the thyroid. Typically, persons affected by Plummer's disease develop a goitre many years before the onset of symptoms of hyperthyroidism; most patients are over age 50 before the characteristic accelerated heart rate and other cardiac conditions appear. Unlike other forms of hyperthyroidism, the disease seldom causes bulging of the eyes (exophthalmos). Swelling of the thyroid gland may obstruct breathing or swallowing, requiring surgery to remove the excess tissue; the cardiac symptoms, resulting in congestive heart failure in some cases, can also be fatal. In the absence of obstruction or cosmetic reasons for removing the gland, the goitre may be treated with drugs that block thyroid activity or with radioactive iodine therapy; however, the multiple thyroid nodules characteristic of the disease may raise suspicion of cancer, necessitating surgical excision of the gland.