Thyroid: history, Investigations & DD.
History: simple goiter is common in girls approaching puberty. Deficient iodide, goitrogens and dyshormonogenesis are also the causes of simple goitre. Multinodular and solitary nodular goitres are found in 20's and 30's. Papillary carcinoma is seen in young girls and follicular Ca in middle aged women. Anaplastic Ca is mainly a disease of old age. Primary toxic goitre (Graves' disease) and Hashimoto's disease are seen in middle age women.
Investigations: Thyroid function tests: T4, T³, TSH (serum thyroid stimulating hormone), radioiodine uptake tests, T³ suppression test.
Thyroid scan: will show which part of the gland is functioning or which part is not (hot or cold).
Miscellaneous tests: BMR, serum cholesterol, serum creatinine, tendon reflexes, ECG, CXR.
Bone scan: exclude early bone metastasis.
DD of thyroid swellings:
Non-toxic (simple) goitre: 1. Diffuse parenchymatus, 2. Colloid, 3. multinodular, 4. solitary nodular.
Toxic goitre: 1.diffuse (graves' disease), 2.multinodular, 3. Toxic (solitary) nodule.
Neoplastic: 1. Benign, 2. Malignant.
Thyroiditis: 1. Acute bacterial, 2. Granulomatous, 3. Autoimmune, 4. Riedel's, 5. Chronic bacterial from TB or syphilis.
Other rare types: Amyloid goitre.