Thyroid Disease

Question 1

What are the three useful investigations in thyroid disease?

Answer 1

• TFTs
  
  • High TSH - hypothyroidism
  • Low TSH - get T3/T4
• Nuclear scan
  
  • Diffuse hyperfunction - Grave’s
  • Nodules - multinodular goitre
  • Hypofunction - thyroiditis/cancer
• Ultrasound

Question 2

What, on ultrasound, would make you suspicious that a thyroid noule was cancerous?

Answer 2

• > 2cm
• Poorly defined margins
• Microcalcifications

Question 3

What treatments might you consider for someone with hyperthyroidism?

Answer 3

• Surgery (now rare)
• Medication (carbimazole, PTU) - risk of autoimmune hepatitis
  
  • PTU used in carbimazole intolerance or pregnancy
• Radioactive iodine
  
  • Permanent hypothyroidism and thyroxine supplementation
• Symptomatic relief
  
  • Beta-blockade (and steroids for thyroiditis)