Is Partial Thyroidectomy Definitive Treatment for Plummer??s Disease (Autonomous Goiter)?

Wiener, Jan D.

doi:10.1097/00003072-198302000-00010

Cited by 13 publications

(10 citation statements)

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“…Some (apparently residual) autonomous tissue was detected scintigraphically in about 20% of patients J . D. Wiener & R. D. ran der Gaag operated for Plummer's disease (Wiener, 1983) but recurrence of a palpable nodule, as found here, was encountered in only 4 of 90 cases. Scintigraphy (Figure 3b) showed the nodule to be hyperactive, with fairly homogeneous activity in the rest of the goitre (estimated at 45 g).…”

Section: R E S U L T Ssupporting

confidence: 51%

“…We saw her again 8 years later as one of a series of patients re-examined after thyroidectomy for Plummer's disease (Wiener, 1983). She was euthyroid (Table 2) with a diffuse goitre that contained a nodule in the same lobe as before.…”

Section: R E S U L T Smentioning

confidence: 96%

“…Plummer's disease, however, is generally not considered to occur on an autoimmune basis. In this disorder part of the thyroid tissue is functioning autonomously while the normal feedback mechanism controls the function in the remainingparenchyma (Cope et al, 1947;Dobyns et al, 1949;Horst, 1953Horst, ,1959Hofer & Vetter, 1959;Wiener, 1975).…”

Section: S U M M a R Ymentioning

confidence: 99%

“…injection of 200 pg TRH. Thyroid scintigraphy was performed with y 9 m T~ as pertechnetate; the presence of localized autonomy was confirmed, where necessary, by repeating this procedure after stimulation with TSH and/or suppression with T3 (Wiener, 1975). Human thyroid adenylcyclase-stimulating Ig (TSI) was determined using dispersed human thyroid cells (Dr Roe1 Docter.…”

Section: P a T I E N T S A N D M E T H O D Smentioning

confidence: 99%

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Autoimmunity and the Pathogenesis of Localized Thyroid Autonomy (Plummer's Disease)

Wiener

Gaag

1985

Clinical Endocrinology

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The pathogenesis of Plummer's disease (localized thyroid autonomy) is incompletely known. It has been shown that a normal thyroid follicle can harbour cells with widely different properties, and hyperactive follicles may arise from cells with both high replicating and hormonogenic potencies under the influence of chronic mild stimulation. We now find thyroid growth-stimulating immunoglobulins (TGI) to be present in low or intermediate titre in the serum of 7 of 9 patients with Plummer's disease. Haemagglutinating antibodies against thyroid microsomal antigen were present in low titre in two of these as well as in three of 21 other patients with this disorder. Two of the patients had a suppressible goitre in addition to the autonomous nodule. One of these is described in more detail. The possibility is discussed that autoimmunity may play a pathogenic role in Plummer's disease. TGI, in relatively low titres as found here, could exert the chronic mild stimulation supposed to be the prime event in the generation of hyperactive follicles. Whether autonomy is intrinsically present in these follicles or triggered by stimulation, remains to be established. Hyperthyroidism supervenes only when the mass of autonomous cells surpasses a certain limit. It appears that these patients with Plummer's disease should be included in the multidimensional spectrum of autoimmune thyroid disease.

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Section: R E S U L T Ssupporting

confidence: 51%

Section: R E S U L T Smentioning

confidence: 96%

Section: S U M M a R Ymentioning

confidence: 99%

Section: P a T I E N T S A N D M E T H O D Smentioning

confidence: 99%

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Autoimmunity and the Pathogenesis of Localized Thyroid Autonomy (Plummer's Disease)

Wiener

Gaag

1985

Clinical Endocrinology

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“…On the whole, complete cure was achieved in all patients with compensated nodules, and either complete or partial cure in all non-toxic and in 86.7% of toxic patients. If the treatment outcome is related to pretreatment nodule volume, either complete or partial cure was obtained in 97.4%, 94.9%, 93.3%, 80% and 42.9% of patients with nodule volumes < 10 ml, [10][11][12][13][14][15][16][17][18][19][20] ml, [20][21][22][23][24][25][26][27][28][29][30] ml, [30][31][32][33][34][35][36][37][38][39][40] ml and > 40 ml, respectively.…”

Section: Worsening Of Thyrotoxicosis (N = 3)mentioning

confidence: 99%