Is partial thyroidectomy definitive treatment for Plummer's disease (autonomous goiter)?

Plummer's disease is a thyroid disorder in which both autonomously functioning and normal tissue is present in the gland. Surgery and I-131 therapy are generally regarded as equally effective for definitive treatment. However, since progression of the disease is very slow, postoperative recurrences should become evident only after many years. We reexamined 87 patients thyroidectomized for Plummer's disease one to 15 (average 7.1) years before the present study. Studies included clinical examination, scintigraphy, and a TRH test. No patient was overly hyperthyroid; one had biochemical hyperthyroidism and another had mechanical complaints. Localized autonomous function was considered present in 18 patients (21%); the TRH test result was abnormal in 10 of these. Postoperative autonomy was found more frequently in males. The scans suggested residual rather than recurrent autonomy in nearly all cases. It is concluded that the presence of residual autonomously functioning thyroid tissue after surgery for Plummer's disease is common and recurrent hyperthyroidism may eventually develop in some of the patients. This knowledge may in some cases turn the scale towards I-131 treatment.