Thyroid disease

Question 1

Thyroid disease

Answer 1

• Patients may present with a number of different manifestations of thyroid disease.
• They can be broadly sub classified according to whether they are euthyroid or have clinical signs of thyroid dysfunction.
• In addition it needs to be established whether they have a mass or not.

Question 2

Assessment?

Answer 2

• History
• Examination including USS
• If a nodule is identified then it should be sampled ideally via an image guided fine needle aspiration
• Radionucleotide scanning is of limited use

Question 3

Thyroid Tumours?

Answer 3

• Papillary carcinoma
• Follicular carcinoma
• Anaplastic carcinoma
• Medullary carcinoma
• Lymphoma’s

Question 4

Multinodular goitre?

Answer 4

• One of the most common reasons for presentation
• Provided the patient is euthyroid and asymptomatic and no discrete nodules are seen, they can be reassured.
• In those with compressive symptoms surgery is required and the best operation is a total thyroidectomy.
• Sub total resections were practised in the past and simply result in recurrent disease that requires a difficult revisional resection.

Question 5

Endocrine dysfunction?

Answer 5

• In general these patients are managed by physicians initially.
• Surgery may be offered alongside radio iodine for patients with Graves disease that fails with medical management or in patients who would prefer not to be irradiated (e.g. pregnant women).
• Patients with hypothyroidism do not generally get offered a thyroidectomy.
• Sometimes people inadvertently get offered resections during the early phase of Hashimotos thyroiditis, however, with time the toxic phase passes and patients can simply be managed with thyroxine.