Wiener J D
Clin Nucl Med. 1987 Mar;12(3):198-203. doi: 10.1097/00003072-198703000-00008.
Plummer's disease presents a spectrum of forms and its evolution is often slow. Longitudinal studies have been limited both in number of patients and duration of follow-up. In order to answer the question of whether euthyroid patients with no local symptoms should be treated prophylactically, 70 patients were reexamined 5.2-21.8 years (average, 8.9) after Plummer's disease had been diagnosed. Data are included on four others who developed symptoms that indicated treatment within five years. Gross (clinically relevant) changes were seen in 24 cases. Of these, 16 were progressive, including 12 where hyperthyroidism developed. Gross regressive changes included two cases with complete remission. Minor changes (28 cases) were about as often regressive as progressive. Most patients with a solitary autonomous nodule showed either gross changes or no change, whereas minor changes prevailed in multifocal autonomy. All eight male patients had a solitary nodule, 28 of 66 females had multifocal autonomy. Gross changes were seen in nine of 12 patients under 40 years at presentation, more often than in those over 49 years; seven of these changes were progressive. Six short case reports illustrate the great diversity in evolution. It is concluded that treatment seems wise in teenagers and in elderly patients with borderline (biochemical) hyperthyroidism but others generally may be left untreated, as long as they have few or no complaints.
普卢默病有多种表现形式，其进展通常较为缓慢。纵向研究在患者数量和随访时长方面都很有限。为了回答无症状的甲状腺功能正常患者是否应接受预防性治疗这一问题，对70例普卢默病确诊后5.2至21.8年（平均8.9年）的患者进行了复查。另外还纳入了4例在5年内出现需治疗症状的患者的数据。24例出现了显著（临床相关）变化。其中，16例为进展性变化，包括12例出现甲状腺功能亢进的情况。显著的退行性变化包括2例完全缓解的病例。微小变化（28例）中，退行性变化和进展性变化的出现频率大致相同。大多数单发自主性结节患者要么出现显著变化，要么无变化，而多灶性自主性病变则以微小变化为主。所有8例男性患者均有单发结节，66例女性患者中有28例有多灶性自主性病变。初诊时年龄在40岁以下的12例患者中有9例出现了显著变化，比49岁以上患者更为常见；其中7例变化为进展性。6篇简短病例报告说明了病情演变的巨大差异。结论是，对于青少年和有临界（生化）甲状腺功能亢进的老年患者，治疗似乎是明智的，但其他患者一般可不治疗，只要他们很少或没有不适症状。
