history and presentation

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  • a goitre indicates an abnormality of the thyroid gland (1)
  • many patients are asymptomatic
  • as a first step look for whether the thyroid is hypothyroid or hyperthyroid
    • look for features hyperthyroidism or hypothyroidism (1)
  • if the thyroid is diffusely enlarged (1)
    • a hyperthyroid state may suggest Graves' Disease
    • a hypothyroid sate may indicate Hashimoto's thyroiditis
  • other features however, may include:
    • pain - in association with:
      • haemorrhage into a nodule
      • de Quervain's or rarely, Hashimoto's thyroiditis
      • rapidly growing neoplasm
    • choking attacks - which may occur even with quite small goitres
  • large, retrosternal tumours may cause:
    • obstruction of the great veins
    • dysphagia
    • stridor - if more than 75% of the diameter of the trachea is compressed
    • recurrent laryngeal palsy - rare
  • features in the history which increase the likelihood that a given nodule represents carcinoma include (3):
    • age < 20 years or >70 years
    • male sex
    • family history of medullary carcinoma or multiple endocrine neoplasia
    • history of radiation exposure to the head and neck
    • symptoms of compression-dysphagia, dyspnoea, cough
  • physical findings suggesting carcinoma include (3):
    • rapid growth in size
    • firm or hard nodule
    • fixation of nodule to adjacent structures
    • nodule > 4cm
    • paralysis of vocal cords
    • enlarged cervical lymph nodes


Last reviewed 01/2018