Goitre

Question 1

What is a goitre

Answer 1

• Swelling of thyroid gland causing lump in front of neck (moves w. swallowing)

Question 2

How common is it

Answer 2

• Affects 9% population

Question 3

Who is affected by it

Answer 3

thyroid cancer more common in women

Question 4

What is the presentation

Answer 4

1. smooth or nodular?
2. Pt euthyroid (functioning), thyrotoxic or hypothyroid
   - smooth, non-toxic = iodine def, congenital, thyroiditis,
   Hashimoto’s thyroiditis
   - Smooth, toxic = Grave’s disease
3. Any nodules?

DIFFUSE

• SIMPLE = no clear cause, ass. w thyroid growth stimulating Ab
• AUTOIMMUNE = hashimoto’s + grave’s - firm, diffuse goitre (variable size)
• THYROIDITIS = acute tenderness in swelling = acute viral thyroiditis (De Quervain’s) ~> prod transient clinical hyperthyroidism w. serum ^ T4

NODULAR

• Multinodular - most common, usually euthyroid (can cause oesophageal/trachea compression + laryngeal palsy)
• Solitary - single thyroid lump - common but hard Dx (maj cysts, adenoma, benign - treat as malignant)
• Fibrotic - REIDEL’S THYROIDITIS -rare - ‘woody’ gland, irregular (ass. systemic sympt)

MALIGNANCY

• Rapid enlargement, lymph node involvement, painful
• RF = prev irradiation, long-standing iodine def, FHx
• lung + bone most common sites metastases

Question 5

What are the risk factors

Answer 5

• Radiation
• FHx
• Iodine deficiency
• Smoking (increases nodular goitre)
• Amiodarone (anti-arrhythmic) + lithium
• Puberty / pregnancy
• Carbimazole will induce (Tx hyperthyroidism)

Question 6

What symptoms

Answer 6

• Often asymptomatic (noticed by others)
• Sometimes cause PAIN + difficulty dyspnoea + dysphagia (compression)
• -> indicates thyroiditis, bleeding into cyst or tumour

Question 7

What are the signs

Answer 7

• Small goitre may be visible on swallowing

Question 8

What are the red flags

Answer 8

• Child w. thyroid nodule
• Unexplained hoarseness or voice changes ass w. goitre
• palpable cervical lymphadenopathy
• Hx of risk factors - FHx, radiation, pain lasting over weeks

Question 9

What are the investigations

Answer 9

• TFT – TSH + free T3/4
• Thyroid antibodies - exclude autoimmune
• USS w fine needle aspiration (FNA) - cystic or solid lumps
• Chest + thoracic XR - check tracheal compression + retrosternal extension
• Thyroid scan - distinguish functioning (hot) + non-function (cold)

Question 10

What is the treatment

Answer 10

Medication - levothyroxine (hypothyroidism)
Surgery
Radioactive iodine