title: Current treatment of nodular goiter with hyperthyroidism (Plummer's disease): surgery versus radioiodine.
abstract: BACKGROUND
  First described 9 decades ago by H. S. Plummer, thyroidectomy and radioiodine remain the 2 therapeutic modalities for toxic nodular goiter. The aim of this study was to determine its optimal treatment.
  
  
  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.
authors.affiliation: Division of Gastroenterologic and General Surgery, Mayo Clinic and Mayo Foundation, 200 2nd Street SW, Rochester, MN 55905, USA.
authors.forename: Ajaipal S
authors.initials: AS
authors.lastname: Kang
authors.forename: Clive S
authors.initials: CS
authors.lastname: Grant
authors.forename: Geoffrey B
authors.initials: GB
authors.lastname: Thompson
authors.forename: Jon A
authors.initials: JA
authors.lastname: van Heerden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006044:Goiter, Nodular / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D006980:Hyperthyroidism / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes