The Autonomously Functioning Thyroid Nodule: Goetsch's Disease

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Abstract
Introduction IN 1913 Henry Plummer (1) described a second type of hyperthyroidism distinct from Graves' disease (or “exophthalmic goiter” as it was called then). In Graves' disease the goiter is diffusely hyperplastic, nearly all such goiters are associated with hyperthyroidism, the hyperthyroidism usually begins within 1 yr of the onset of the goiter, and exophthalmos is common. In Plummer's disease, there are one or more nodular lesions, only about one-fourth of these nodular goiters are associated with hyperthyroidism, the goiter precedes the hyperthyroidism by an average of about 15 yr, and exophthalmos is not seen. Fundamental differences in pathophysiology are now appreciated. Graves' disease is viewed as an autoimmune disorder in which thyroid-stimulating immunoglobulins are elaborated that induce hypertrophy, hyperplasia, and hypersecretion of thyroid hormone in the thyroid gland diffusely. In Plummer's disease the follicular components of the nodular lesions secrete thyroid hormone independently of any extrathyroidal stimulators, normal or abnormal, i.e. autonomously. Autonomously functioning nodules may exist in close approximation to and within normal thyroid parenchyma that remains subject to the functional regulation of the pituitary.

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