Thyroid nodules Flashcards
What is thyrotoxicosis + tender goitre
Subacute - de quervians - thyroiditis
What is de quervians thyroiditis
Thyrotoxicosis and painful goitre following history of viral illness, initial hyperthyroid phase and raised ESR
Treatment for de quervians
Napreoxen - self limitng condition only need pain relief
If severe - steroids, esp in hypothyroidism stage
Phases of de quervians thyriditis
phase 1 (lasts 3-6 weeks): hyperthyroidism, painful goitre, raised ESR
phase 2 (1-3 weeks): euthyroid
phase 3 (weeks - months): hypothyroidism
phase 4: thyroid structure and function goes back to normal
Investigations for de quervians
Thyroid scintigraphy - reduced iodine uptake globally
What is main risk for toxic thyroid nnodule eg adenoma
Dietary iodine deficiecny
Who does thyroid adenoma affect
women 20-40
What are toxic adenomas
benign, encapsulated, hyper-functional adenomas
From proliferation of follicular cells
On examination thyroid nodules adenoma
> 3cm to cause symptoms - palpable
Tracheal deciation if large
Tachycardia
Lid lag
Absence of exophthalmos
Investigations for adenomanodule bloods results
TFTs - Raised T3/4
Negative antiTPO and TSH receptor antibodies
ESR - rule out thyroidits
Imaging for adenoma thryoid
US - characterise and confirm adenoma
Radioisotope 99mtehcneum, 131 iodine - hot nodules - diagnostic
Dont need biospy if benign on US and + PET
ECG - AF
What os toxic multinodular goirter
Large irregular goitre - multiple nodule
>40 years
Toxic multinodular goitre vs thyroid adenoma on radioisotope scan
Hot and cold areas on radiosotope scan vs solitary hot for adenoma
Little to no uptake in thyroidits
Thyroiditis presentation
AI inflammation = small palpable goitre may be present
Raised ESR
When is thyroiditis more common in women
Post natal period
