Multinodular goitre

140 Multinodular goitre



Instruction


Examine this patient’s neck.



Salient features



History




• Stridor: trachea must be narrowed to 20–30% for this symptom


• Hoarseness of voice (caused by pressure on recurrent laryngeal nerve), suggests thyroid malignancy


• Acute painful enlargement, suggests bleeding into thyroid nodule


• Suffusion of face when the patient raises the arms above the head, suggests substernal goitre


• Dysphagia


• Deafness: if caused by eighth cranial nerve involvement suggests Pendreds syndrome (rare)


• Symptoms of thyroid hyper- or hypofunction


• Family history of thyroid cancer.



Examination




• Middle-aged or elderly patient


• Multinodular goitre (Fig. 140.1)


• Atrial fibrillation


• Signs of thyrotoxicosis (p. 516)


image

Fig. 140.1 Large nodular goitre.


(With permission from Zimmermann et al. 2008.)



Diagnosis


This patient has a multinodular goitre (lesion) and is hyperthyroid with atrial fibrillation (functional status).



Questions




What is the natural history of thyrotoxicosis in nodular goitre?


It is permanent and there are no spontaneous remissions; therefore, antithyroid drugs to decrease thyroid hormone secretion are not appropriate for long-term therapy.



How would you investigate a nodular goitre?




• Serum thyroid-stimulating hormone (TSH) and free thyroxine (T4) should be measured to identify those with subclinical or overt hyperthyroidism. If the TSH is suppressed, radionuclide scanning should be performed.


• Ultrasonography of the thyroid gland indicates whether goitre is cystic or solid:


• If solid, perform a radioisotope scan to indicate hot or cold nodule

• If cold nodule, fine-needle aspiration.

Related posts:

  1. Permanent cardiac pacemaker/implantable cardioverter-defibrillator
  2. Cauda equina syndrome
  3. Dermatomyositis
  4. Arteriovenous fistula

Stay updated, free articles. Join our Telegram channel
Tags:
Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Multinodular goitre

Full access? Get Clinical Tree
Get Clinical Tree app for offline access