ABSTRACT

Toxic multinodular goiter (TMNG), also named Plummer’s disease according to Henry Stanley Plummer who rst described a “non-hyperplastic toxic goiter” in 1913, is a cause of hyperthyroidism due to the presence of one or more autonomously

19.1 Denition ...................................................................................................... 317 19.2 Epidemiology ................................................................................................ 318 19.3 Etiology ......................................................................................................... 319 19.4 Natural Course .............................................................................................. 320 19.5 Clinical Features ........................................................................................... 320

19.5.1 Cardiovascular System ..................................................................... 321 19.5.2 Gastrointestinal Apparatus ............................................................... 323 19.5.3 Bones, Joints, and Calcium Metabolism ........................................... 323 19.5.4 Skin ................................................................................................... 324 19.5.5 Neuromuscular System ..................................................................... 324 19.5.6 Specic Presentations ....................................................................... 324

19.6 Diagnosis ......................................................................................................324 19.6.1 Clinical ............................................................................................. 324 19.6.2 Laboratory ........................................................................................ 326 19.6.3 Imaging ............................................................................................. 327

19.7 Treatment ...................................................................................................... 328 19.7.1 Radioiodine ....................................................................................... 329 19.7.2 Surgery .............................................................................................. 331 19.7.3 Medical Treatment ............................................................................ 332

19.7.3.1 Antithyroid Drugs .............................................................. 332 19.7.3.2 Beta-Adrenergic Blocking Agents ..................................... 334

19.7.4 Alternative Options ........................................................................... 334 19.8 Prognosis ....................................................................................................... 335 19.9 Follow-Up ..................................................................................................... 335 References .............................................................................................................. 337

tioning thyroid nodules. Thyroid scintigraphy shows the co existence of areas of different uptake levels (increased, hot and reduced, cold nodules).