[Guest]

I've seen a question in USMLE consult that confused me between Grave's disease and Plummer disease.
What's plummer disease and how should we differentiate it from Grave's?

 

[khanar]

Plummer disease is the second most common cause of hyperthyroidism in USA. The term is synonymous with Toxic Multinodular Goitre. Unlike Grave's it's not an autoimmune disease and therefore no eye manifestations and no female predilaction. It's due to autonomously producing adenomas and it's more common in older ages. Treatment is usually surgery rather than antithyroid medications.

 

[FSUSTC]

Graves disease : autoimmune disease
Plummer disease : non autoimmune disease

 

[Karrar]

How can we differentiate between Plummer's & Grave's diseases??

You can differentiate Plummer's from Grave's diseases clinically by 3 main points, these are:

- First, Plummer's disease tends to occur more often in elderly people, while Grave's dz. is affecting mostly young age group.

- Second, Plummer's dz. manifestations are mostly cardiac (tachcardia, any type of arrhythmias-except Heart block ,..etc) With little or absent eye signs of thyrotoxicosis. In contrast, Grave's disease exhibits marked eye manifestations with little or no cardiac signs.

- Third, Also you can palpate the Thyroid to find out whether it has nodular suface (Plummer's) or smooth surface with diffusly enlarged glang (Grave's).

 

[matz]

in addition to what others said i can add that in Grave's ds there is a diffuse general excessive production of hormone in thyroid gland, while toxic adenoma (plummer ) is only one hot nodule of hormone production, as u see also in radioactive iodine uptake .

 

[hana]

goljan;
plummer's ;lack of exophtalmus and pretibial myxedema.