Thyroid Nodules Flashcards
What is Plummer’s disease
Toxic multi nodular goitre - several autonomously functioning thyroid nodules leading to thyrotoxicosis
Who does TMG most commonly affect
Middle aged or elderly women - risk factors include iodine deficiency or sudden increase in iodine (amiodarone), previous radiation or head/neck irritation
How does TMG present
- Hyperthyroidism
- Lid lag - increased contraction of levator palpebra
- Neck compression (hoarseness, cough, SOB)
Describe the goitre in TMG
Nodular goitre - irregular rather than symmetrical smooth goitre seen in graves
What investigations are done in TMG
TFTs will reveal primary hyperthyroidism - radioisotope scan (scinitgraphy) will show patchy uptake with hot and cold areas
How is TMG managed
Radioiodine - thyroidectomy if this is not possible
When does de Quervains occur
Following viral infection
What are the 4 phases of de Quervains
- Hyperthyroid, painful goitre, raised ESR (brief period)
- Euthyroid
- Hypothyroid (longest phase)
- Resolution
What do investigations show in de Quervains
TFTs
Inflammatory markers
Nuclear scintigraphy - globally reduced iodine uptake
How is de Quervains managed
- Self limiting
- Pain may respond to aspirin/ NSAIDs
- Steroids if severe hypothyroidism develops
What are the types of thyroid cancer - most to least common
- Papillary - most common, best prognosis
- Follicular
- Medullary - associated with MEN2, affects parafollicular cells, secretes calcitonin
- Anaplastic - affects old women, worst prognosis
- Lymphoma - associated with Hashimoto’s
How do we investigate thyroid cancer
USS of thyroid
TFTs
Fine Needle Aspiration
How do we manage papillary and follicular thyroid cancer
- Total thyroidectomy
- Radioiodine to kill residual cells
- Yearly thyroglobulin levels measured to prevent recurrence
How do we manage anaplastic carcinoma
Resection where possible - poor prognosis and typically doesn’t respond to treatment
