history and presentation
Last reviewed 01/2018
- 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
-
pain - in association with:
- 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
Reference: