Next to diabetes, thyroid disease is the most common endocrine condition. GPs manage most patients with hypothyroidism; other thyroid conditions usually require joint working with specialists.

Pathology

Thyroid disease can essentially be broken down into physiological change, autoimmune disease, presenting as hyperthyroidism or hypothyroidism, and benign or malignant lumps in the neck. Malignancy is rare.

A Lump in the Neck

Physiological goitre is common and caused by ‘puberty, pregancy and poverty’, the former from increased demand, the last from decreased supply in those parts of the world where dietary iodine is low and supplements not available. This may be worsened by diets containing goitrogens (e.g. cabbage which has a thiouracil-like action). In Japan, seaweed eating produces goitre from iodine excess. Be aware that kelp (seaweed) found in many health tonics contains large amounts of iodine and may produce goitre or transiently interfere with thyroid function. Patients with physiological goitre are normally euthyroid and asymptomatic.

Autoimmune goitre: both thyroid stimulation and destruction by autoantibodies can both lead to goitre and often the two processes coexist (although known as Graves’ and Hashimoto’s diseases). The soft diffuse swelling in Graves’ disease is the most common autoimmune goitre.

Thyroid nodules are common but only occasionally toxic. The main issue is to differentiate the rare malignancy from the rest. Benign nodules might appear single but scanning often reveals them to be multiple.

Thyroid tumours are rare. Warning signs are single, sometimes painful nodules, growing rapidly and fixed to deep structures or skin. Check for local lymph nodes.

Stay updated, free articles. Join our Telegram channel

Join