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Toxic Nodular Goiter or Plummer Disease : Causes, Symptoms, Treatment, Complications

Thyroid gland is a very important endocrine gland of our body. It produces thyroid hormones, T3 and T4. These hormones contain iodine in them. Thyroid hormones regulate body’s metabolism. Any problems to thyroid gland such as hyperthyroidism (increased production of thyroid hormones) or hypothyroidism (decreased production of thyroid hormones) affect body’s metabolism severely.

The thyroid gland is situated at the base of the neck. At times this gland becomes big in size. The abnormal enlargement of thyroid gland is called Goiter. It develops because the entire gland is swollen or the gland has multiple growths (nodules) on it. It is often seen as a bulge in the neck. Goiters occur due to different reasons such as iodine deficiency, Graves disease, Hashimoto’s disease, thyroid nodules, inflammation of the thyroid (thyroiditis) and thyroid cancer.

What is Toxic Nodular Goiter or Plummer Disease?

What is Toxic Nodular Goiter or Plummer Disease?

Toxic nodular goiter (TNG) or Plummer Disease is a medical condition where the gland has developed nodule or adenoma in it. This nodule produces excess of thyroid hormones which leads to hyperthyroidism. One overactive nodule is called as toxic nodule. More than one nodule is called toxic multinodular goiter and it produces greater amounts of thyroid hormone. Nodular goiters are non-cancerous. Toxic nodular goiters are mostly seen in women over the age of 50 years. It rarely affects children. Toxic nodular goiter or TNG is also called as Plummer’s disease as it is named after its founder Henry Plummer.

Symptoms of Toxic Nodular Goiter or Plummer Disease

Symptoms of toxic nodular goiter or Plummer disease are similar to hyperthyroidism which is as follows:

Causes of Toxic Nodular Goiter or Plummer Disease

The main cause of toxic nodular goiter or Plummer disease is Iodine deficiency. Since, there is less amount of iodine in the body, the thyroid gland reacts to the less amounts of iodine by growing in size to increase hormone production. The other causes include:

  • In some cases, it is also caused due to injection of iodine (as contrast agents) in blood during CT scan, which may trigger increased production of thyroid hormone.
  • Intake of iodine containing medicines such as amiodarone may also cause toxic nodular goiter.

Diagnosis of Toxic Nodular Goiter or Plummer Disease

  • The diagnosis includes questions related to medical history and observing the signs and symptoms.
  • Blood tests include determining levels of hormones like decreased levels of Thyroid stimulating hormones (TSH) and increased levels of T3 and T4 hormones indicating hyperthyroidism.
  • Ultrasound imaging of the thyroid gland to check for presence of nodules. If there is increase in uptake of iodine means there is more number of nodules.

Treatment of Toxic Nodular Goiter or Plummer Disease

The treatment methods or toxic nodular goiter or Plummer disease include:

  • Drugs which are Beta blockers such as propranolol can regulate the symptoms of hyperthyroidism.
  • Use of radioactive iodine and anti-thyroid drugs like propylthiouracil and methimazole. These drugs reduce excess hormone production.
  • Surgical removal of the entire thyroid gland known as thyroidectomy may be performed in some cases.
  • Laser ablation is a new method to remove nodules.

Complications of Toxic Nodular Goiter or Plummer Disease

A number of complications can arise due to toxic nodular goiter or Plummer diseases which are the following:

  • Enlarged goiter causes difficulty in swallowing and breathing.
  • Heart problems such as rapid heart rate, irregular heart beat and congestive heart failure.
  • Loss of bone due to osteoporosis.
  • Thyroid crisis or thyroid storm which requires urgent medical attention. It shows symptoms such as abdominal pain, fever and mental confusion.


Toxic nodular goiter or Plummer disease is a condition mostly occurring in elderly women. Treatment can be started; however, prognosis may not be always good if associated with other health problems.


  1. Mayo Clinic – Thyroid nodules: https://www.mayoclinic.org/diseases-conditions/thyroid-nodules/symptoms-causes/syc-20355262
  2. American Thyroid Association – Hyperthyroidism (Overactive): https://www.thyroid.org/hyperthyroidism/
  3. National Institute of Diabetes and Digestive and Kidney Diseases – Thyroid Tests: https://www.niddk.nih.gov/health-information/diagnostic-tests/thyroid

Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:August 1, 2023

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