Goitres.

Enlarged thyroid gland irrespective of cause.

Physiological or pathological.

Can be endemic/familial or sporadic.


Diffuse.

  • Graves.
  • Simple.
  • Thyroiditis.

Single nodule.

  • Adenoma.
  • Carcinoma,

Multi – nodular.

  • Toxic multi – nodular.
  • Hashimotos.

7% have a palpable / visible goitre.

F > M by 4.

Can have nodules in ½ population –asymptomatic on US.

Occult cancer in up to 50% of PM glands.

History.

  • Rapid growth?                       
  • Drugs? RT?                                   –lithium,iodine excess.
  • Iodine deficient area?
  • Childhood radiation?             - benign and malignant risk.
  • Age?                                        Nodule in chilhood often lymphoma.
  • FHx?                                       Often auto-immune.
  • Painful?                                   Thyroiditis.
  • Recent pregnancy?
  • Puberty

Examination.

  • Size.
  • Diffuse or nodular?
  • Tender?
  • Mobility.
  • Consistency                   -stone in cancer,hard in thyroiditis.
  • Thrill or bruit?                Hyperthyroid.
  • Cervical LN?
  • Compression – sob, dysphagia, svc compression, hoarseness
  • Toxicity – tachy, tremor and exophthalmosis

Investigations.

  • TFTs.
  • TRAB.
  • Thyroglobulin.
  • Anti TPO.
  • US.
  • MRI.
  • FNAC.
  • Radio-nucleitide imaging.

Malignancy.

Papillary.

  • 80%
  • Young females.
  • Surgery.
  • Mortality <5%.

Follicular.

  • Older females.
  • Mets.

Anaplastic.

  • Poor prognosis.

 

Thyroid storm can be triggered in anyone with hyperthyroidism but usually if unwell.