Diagnostic items and treatment of Plummer's disease: a study on 180 patients.

Objective: The aim of this study was to evaluate clinical data of patients who have been undergone to medical, radionuclide, surgical and percutaneous ethanol injection (PEI) treatment of autonomous "hot nodule", to establish the real value of these therapeutical strategies.

Patients And Methods: The authors analyzed their experience based on 180 Plummer's disease (PD) from January 1990 to December 1997. 49 nodules have been submitted to FNA.

Results: The functional stage of PD was partially autonomously in 47 patients, pretoxic nodule in 98 patients and in toxic phase in 35 patients. The more frequent ultrasonographic type has been a solid nodule with abundant intranodular vascularization to color flow duplex Doppler evaluation. The medical therapy has brought to a resolution of the toxic phase in 71.2% of the patients, while 6.4% of the patients developed a recurrent hyperthyroidism. The surgical treatment of the patients with hyperthyroidism has resolved hyperthyroidism symptoms in 87.5% of cases. The therapy with radioactive iodine determined a metabolic normalization in 73.7% of the cases and an hypothyroidism in 89.5% of the cases. Our results, in 12 patients treated with PEI, followed-up through 12 months, have been excellent: total remission in 75% of the patients and no recurrent hyperthyroidism crisis.

Conclusions: It doesn't exist a single therapy to treat the PD. The surgical or radionuclide treatment could be addressed to the big or toxic nodules insensible to pharmacological therapy and the PEI represent a new method to treat the PD because of efficacious, harmless, cheap and practical too.