Thyroid Disease

Differential Diagnosis - (Central neck lump)

Goitre   Diffuse   Graves' Disease (Hyperthyroid) Simple goitre (Euthyroid) Hashimoto's Thyroiditis (Euthyroid, Hypothyroid) De Quervain Thyroditis (Euthyroid, Hyperthyroid) Iodine deficiency (Euthyroid, Hypothyroid) Multinodular   Multinodular goitre (Euthyroid) Toxic multinodular goitre (Hyperthyroid) Solitary nodule   Thyroid colloid cyst (Euthyroid) Simple adenoma (Euthyroid) Toxic adenoma (Euthyroid, Hyperthyroid) Follicular carcinoma (Euthyroid, Hypothyroid) Cyst   Thyroglossal Sebaceous / Epidermal Branchial Cystic Hygroma Pharyngeal pouch Lipoma

Symptoms

Hyperthyroidism   Neck lump Heat intolerance Weight loss despite increased appetite Irritability & mood swings Diarrhoea Palpitations Tremor Sweating

Signs - (Physical Examination)

Hyperthyroidism   Goitre Proximal myopathy Brisk reflexes Tachycardia or atrial fibrillation (AF) Fine tremor Graves' Disease   Exopthalmos Proptosis Lid lag

Investigations

Bloods   TFT FBE   Leukocytosis - thyroiditis Imaging   U/S - Solitary nodule, to exclude cyst & diagnose retrosternal extension Radioisotope Thyroid Scan - Diffuse & Multinodular goitre Chest X-Ray if tracheal or mediastainal compression suspected Biopsy   FNA - For solitary nodules

Treatment

Medical   Acture symptomatic treatment   B-Blockers - Propanolol Antithyroid medication   Carbimazole Radioactive Iodine   Oral doses of radioactive iodine Results are slow and unpredictable Not advised in the young Absolutely contraindicated in pregnancy Late hypothyroidism often occurs Thyroidectomy   Indications   Young patient Grave's Disease No response to antithyroid drugs Toxic multinodular goitre Adenocarcinoma Preoperative   When possible, ensure TFT within normal range Determine recurrent laryngeal nerve function Complications   Haemorrhage causing tracheal compression causing airway obstruction - Surgical exloration Laryngeal oedema causing airway obstruction - Intubation Recurrent laryngeal nerve damage Thyrotoxic crisis - Tachycardia, Agitation, Pyrexia, Sweating Hypothyroidism - Patients on Thyroxine for life Hypoparathyroidism - Due to inadvertent damage during surgery Anaesthetic complications General Complications