Nodular thyroid disease

Question 1

Solitary thyroid nodule - are most benign or malignant?

Answer 1

Benign

Question 2

Solitary thyroid nodule - who gets it?

Answer 2

Elderly, males

Question 3

Solitary thyroid nodule - causes

Answer 3

Exposure to radiation

FHx thyroid cancer

Question 4

Solitary thyroid nodule - clinical features (benign)

Answer 4

Lump in the thyroid region which moves on swallowing

Painless

Question 5

Solitary thyroid nodule - clinical features (malignant)

Answer 5

Firm, hard, immobile lump on thyroid
Dysphagia
Hoarse voice
Cervical lymph nodes

Question 6

Solitary thyroid nodule - investigations

Answer 6

Thyroid function tests: TSH, free T3 and T4 levels
Scintigraphy: high uptake
Thyroid US with FNA: distinguishes benign from malignant
Thyroid uptake scan (radioactive iodine)
Auto-antibodies: -ve

Question 7

Solitary thyroid nodule - management

Answer 7

Radio-active iodine

Surgery

Question 8

Multi nodular goitre - definition

Answer 8

Functioning autonomous nodules that secrete large amounts of thyroid hormones

Question 9

Multi nodular goitre - cause

Answer 9

Iodine deficiency

Question 10

Multi nodular goitre - investigations

Answer 10

Thyroid functions tests: TSH, free T3 and T4 levels
US, CT scan
Thyroid uptake scan (radioactive iodine) - lots of different nodules taking up, patchy

Question 11

Multi nodular goitre - management

Answer 11

Most are left untreated
Radio-active iodine
Surgery

OR

Long term carbimazole at very low dose