Endocrine: Goitre

Question 1

what is a goitre?

Answer 1

abnormal enlargement of the thyroid gland - causes a lump at the front of the neck which will move up and down when the patient swallows

NB: usually painless

Question 2

what hormones does the thyroid gland produce?

Answer 2

thyroxine (T-4) and triiodothyronine (T-3)
calcitonin

NB: all secreted due to release of thyroid-stimulating hormone (TSH) from pituitary gland

Question 3

what hormone does the pituitary gland produce that influences the thyroid gland?

Answer 3

thyroid-stimulating hormone (TSH)

Question 4

what is the most common cause for a goitre?

Answer 4

lack of iodine in the diet

Question 5

what are some risk factors for a goitre?

Answer 5

• iron deficiency
• hyperthyroidism (Graves disease)
• hypothyroidism (hashimoto’s disease)
• multi-nodular goitre
• Solitary thyroid nodules.
• Thyroid cancer.
• Pregnancy and menopause
• Thyroiditis.
• Being female.
• increasing age.
• Radiation exposure to neck or chest area.

Question 6

why is pregnancy and menopause a risk factor for goitre?

Answer 6

A hormone produced during pregnancy, human chorionic gonadotropin (HCG), may cause your thyroid gland to enlarge slightly.

Question 7

what are some clinical features of a goitre?

Answer 7

Not all goitres cause signs and symptoms. When signs and symptoms do occur they may include:

• A swelling at the base of the neck which may or may not be obvious.
• A tight feeling in the throat.
• Coughing.
• Hoarseness.
• Difficulty swallowing.
• Difficulty breathing.

Question 8

which conditions present in a similar way to a goitre?

Answer 8

Thyroid carcinoma.
Fibroma.
Granulomatous disease of the thyroid.
Lipoma.
Parathyroid adenoma.
Pseudogoitre.
Sarcoma.
Thyroiditis.
Lymphoma.
Thyroid nodule.

Question 9

what investigations would you conduct to confirm a diagnosis of a goitre?

Answer 9

• physical examination
• TFTs
• ultrasound
• fine needle aspiration biopsy

Question 10

how would you physically examine someones thyroid gland?

Answer 10

• Observe the neck from the side and look for presence of a goitre.
• Ask the patient to swallow – the thyroid should move upon swallowing
• Auscultation – soft bruits over the inferior thyroidal artery (toxic goitre)
• Palpation – rules out pseudogoitre (commonly suspected in thin individuals)

Question 11

what is the treatment for a goitre?

Answer 11

• medication to solve hypo/hyperparathyroidism
• surgery to remove part of thyroid gland
• Radioactive iodine