Goitre
| Incidental findings | |
| +ve signs | Multinodular / diffusely enlarged / solitary nodule, ?Tender, ?Lymph nodes, ?R/L lobe enlarged more, Thyroid bruit. |
| Differential diagnosis | See below |
| Function | Thyroid status. |
| Tests |
TSH, fT4 Thyroid autoantibodies ±USS with FNA ±Radioisotope scan |
|
Multinodular enlargement Multinodular goitre |
Diffuse enlargement Grave’s disease Simple goitre Hashimotos |
Single nodule Dominant nodule Adenoma Cyst Carcinoma |
Extensions
- Assess thyroid status
- Ask the patient some questions
Notes
- Drugs: Carbimazole / propylthiouracil. High rates of relapse. Carbimazole associated with agranulocytosis.
- Radioiodine indications: (i) Grave’s with moderate goitre. No signifcant eye signs (ii) Toxic multinodular goitre in older presons (iii) toxic ademnoma.
- Radioiodine copntraindications: Breastfeeding, pregnancy, incontinence.
- Radioiodine advice: Avoid public transport, close contact with others for 12 days. Avoid children, pregnant women 27 days. Avoid pregnancy for 4 months. May have transient worsening of symptoms.