PassMED: Medical Finals Examination Revision

Goitre

Signs	Multinodular / diffusely enlarged / solitary nodule, ?Tender, ?Lymph nodes, ?R/L lobe enlarged more, Thyroid bruit.
Differential diagnosis	See below
Function	Thyroid status.
Tests	TSH, fT4 Thyroid autoantibodies +/-USS with FNA +/-Radioisotope scan

Multinodular enlargement
Multinodular goitre

Diffuse enlargement
Grave's disease
Simple goitre
Hashimotos

Single nodule
Dominant nodule
Adenoma
Cyst
Carcinoma

Drugs: Carbimazole / propylthiouracil. High rates of relapse. Carbimazole associated with agranulocytosis.
Radioiodine indications: (i) Grave's with moderate goitre. No signifcant eye signs (ii) Toxic multinodular goitre in older presons (iii) toxic ademnoma.
Radioiodine contraindications: Breastfeeding, pregnancy, incontinence.
Radioiodine advice: Avoid public transport, close contact with others for 12 days. Avoid children, pregnant women 27 days. Avoid pregnancy for 4 months. May have transient worsening of symptoms.