TOXIC MULTINODULAR GOITRE

Question 1

What is Toxic Multimodular Goitre?

Answer 1

multiple autonomously functioning nodules on an enlarged thyroid, resulting in hyperthyroidism

Question 2

What causes Toxic Multinodular Goitre?

Answer 2

Iodine Deficiency leads to decreased T4 production > causes hyperplasia

Question 3

What is the symptoms of Toxic Multinodular Goitre?

Answer 3

Diarrhoea

Weight loss

Increased appetite

Sweat and Heat Intolerance

Dysphagia and Dyspnoea

Palpitation and Tremor

Pruritis

Oligomenorrhoea

Question 4

What is the signs of Toxic Multinodular Goitre?

Answer 4

Tachycardia and Irregular pulse

Difficulty breathing

Warm, mois hand

Fine Tremor

Irregular Goitre

Stare or Lid Lag

Question 5

What is the risk factors of toxic Multinodular Goitre?

Answer 5

Iodine deficiency

Age >40

Head and neck radiotherapy

Question 6

What are your top differentials for Toxic Multinodular Goitre?

Answer 6

Grave’s Disease

Toxic Adenoma

Question 7

What are the blood test done in Toxic Multinodular Goitre?

Answer 7

FBC: anaemia or Leukocytosis

TSH: very low

SERUM T3/4: high

RADIOACTIVE IODINE REUPTAKE: hot and cold areas

Question 8

Which imaging would you request for in Toxic Multinodular Goitre?

Answer 8

NECK CT: large goitre

THYROID ULTRASOUND: determines size and shape

Question 9

Which antithyroid drugs are used in management of Toxic Multinodular Goitre?

Answer 9

Thiamazole

Used 3-5days before I-131 and 3-5days after

Question 10

What is the first line treatment of Toxic Multinodular Goitre?

Answer 10

Radioactive Iodine Therapy (I-131)

Question 11

When is thyroidectomy performed?

Answer 11

If suspecting malignancy

If the mass is causing obstructive symptoms such dysphagia or dyspnoea

If cold nodule suspected