Endocrine: Thyroid Nodule

Question 1

what is a thyroid nodule?

Answer 1

Thyroid nodules are solid or fluid-filled lumps that form within your thyroid. The great majority of thyroid nodules aren’t serious and don’t cause symptoms.

Question 2

what are some risk factors for a thyroid nodule?

Answer 2

• iron deficiency
• thyroid adenoma
• thyroid cyst
• thyroiditis
• multinodular goitre
• thyroid cancer
• exposure to radiation
• smoking
• family history

Question 3

what are some clinical features of a thyroid nodule?

Answer 3

Most thyroid nodules don’t cause signs or symptoms. Occasionally, however, some nodules become so large that they can:

• Be felt.
• Be seen.
• Press on your oesophagus, causing shortness of breath or difficulty swallowing.

Question 4

what signs on examination may you find for a patient with a thyroid nodule?

Answer 4

Movement of thyroid on swallowing / enlargement or asymmetry / lumps /lymphadenopathy.

Question 5

In some cases, thyroid nodules can produce additional thyroxine. The extra thyroxine can cause what kind of symptoms?

Answer 5

Unexplained weight loss.
Increased perspiration.
Tremor.
Nervousness.
Rapid or irregular heartbeat.

Question 6

which conditions can present in a similar way to a thyroid nodule?

Answer 6

Goitre.
Grave’s disease.
Hashimotos thyroiditis.
Thyroid cyst.
Thyroid adenoma.
Colloid nodule.
Hypercystic nodule.

Question 7

what investigations would you do to confirm a diagnosis of a thyroid nodule?

Answer 7

• physical exam
• TFTs to see if producing any hormones
• ultrasound to distinguish cysts from solid nodules
• fine-need aspiration biopsy

Question 8

what is the treatment for a benign thyroid nodule?

Answer 8

• watch and wait
• levothyroxine (supplying additional thyroid hormone will signal the pituitary to produce less TSH, the hormone that stimulates the growth of thyroid tissue)
• surgery for large nodules

Question 9

what is the treatment for a thyroid nodule that causes hyperthyroidism?

Answer 9

Radioactive iodine therapy WITH High-dose antithyroid drugs: thiamazole.

Surgery (subtotal thyroidectomy).

Question 10

what is the treatment for a malignant thyroid nodule?

Answer 10

near-total thyroidectomy

alcohol-ablation

Question 11

what are some complications of thyroid nodules?

Answer 11

• possible problems swallowing or breathing
• hyperthyroidism
• problems associated with thyroid cancer