CHAPTER 11 Endocrine surgery
Thyroid
Congenital
Symptoms of thyroid disease
Lump in the neck
• Smooth non-toxic enlargement of the gland. This is characteristic of a physiological goitre, which may occur at puberty or in pregnancy
• A smooth firm enlargement of the gland (occasionally asymmetrical), usually in middle-aged females and often associated with hypothyroidism, e.g. Hashimoto’s disease
• A solitary nodule in a lobe of the thyroid gland. This may be due to a palpable dominant nodule in a multinodular goitre, a cyst, an adenoma or a carcinoma
• A rapid increase in the size of nodule associated with haemorrhage into a cyst, a rapidly growing carcinoma or thyroiditis, which may be painful
Hoarse voice
This is due to pressure on and/or malignant infiltration of one or both recurrent laryngeal nerves.
Investigation of thyroid dysfunction/swellings
Goitre
A goitre is an enlargement of the thyroid gland (for Classification → Table 11.1).
Simple (non-toxic goitre) | Simple hyperplastic goitre Multinodular goitre |
Toxic goitre | Diffuse (Graves’ disease) Toxic nodule (adenoma) Toxic multinodular goitre |
Neoplastic goitre | Benign: Malignant: |
Inflammatory | De Quervain’s thyroiditis Riedel’s thyroiditis |
Autoimmune | Hashimoto’s thyroiditis |