Goitre

Question 1

What is a goitre?

Answer 1

An abnormal enlargement of the thyroid gland.

Question 2

What are the two main types of goitre?

Answer 2

Smooth goitre and nodular goitre.

Question 3

What is a smooth goitre?

Answer 3

Diffuse enlargement of the thyroid gland without distinct nodules.

Question 4

What is a nodular goitre?

Answer 4

Enlargement of the thyroid gland with one or more discrete nodules.

Question 5

How can nodular goitres be functionally classified?

Answer 5

Hot (functioning) nodules and cold (non-functioning) nodules.

Question 6

What is the most common cause of goitre worldwide?

Answer 6

Iodine deficiency.

Question 7

What is the most common cause of goitre in the UK?

Answer 7

Graves’ disease.

Question 8

Name causes of smooth goitre.

Answer 8

Graves’ disease, Hashimoto’s thyroiditis, lithium, amiodarone, iodine deficiency or excess, De Quervain’s thyroiditis, infiltrative diseases such as sarcoidosis and haemochromatosis.

Question 9

Name causes of nodular goitre.

Answer 9

Toxic solitary adenoma, non-functional thyroid adenoma, multinodular goitre, thyroid cyst, thyroid cancer.

Question 10

What autoimmune condition causes hyperthyroidism and smooth goitre?

Answer 10

Graves’ disease.

Question 11

What autoimmune condition causes hypothyroidism and smooth goitre?

Answer 11

Hashimoto’s thyroiditis.

Question 12

Which drugs are commonly associated with goitre formation?

Answer 12

Lithium and amiodarone.

Question 13

What are the key examination features of a thyroid goitre?

Answer 13

A neck swelling that moves on swallowing but does not move with tongue protrusion.

Question 14

What symptoms suggest a large or compressive goitre?

Answer 14

Hoarseness, dysphagia, dyspnoea.

Question 15

How may thyroid function symptoms vary in patients with goitre?

Answer 15

Patients may have symptoms of hyperthyroidism, hypothyroidism, or be euthyroid depending on the cause.

Question 16

What are important differential diagnoses for a goitre?

Answer 16

Thyroid lymphoma, thyroglossal duct cyst, branchial cleft cyst.

Question 17

How does a thyroglossal duct cyst differ from a goitre on examination?

Answer 17

It moves with swallowing and tongue protrusion.

Question 18

What is the first-line imaging investigation for goitre?

Answer 18

Thyroid ultrasound.

Question 19

Why is ultrasound important in nodular goitre?

Answer 19

It assesses nodule size, number, and suspicious features.

Question 20

When is fine-needle aspiration (FNA) indicated in goitre?

Answer 20

In nodular goitre to assess for malignancy.

Question 21

What blood tests are essential in the investigation of goitre?

Answer 21

Thyroid function tests (TFTs).

Question 22

When can goitre be managed conservatively?

Answer 22

Small, asymptomatic goitres without concerning features.

Question 23

What medical treatments are used for goitre?

Answer 23

Antithyroid drugs for hyperthyroidism and levothyroxine for hypothyroidism.

Question 24

What are indications for surgical management of goitre?

Answer 24

Compressive symptoms, suspected or confirmed malignancy, cosmetic concerns, or large symptomatic goitres.

Question 25

What are the main complications of goitre?

Answer 25

Airway or oesophageal compression and malignancy in nodular goitre.

Question 26

What determines prognosis in patients with goitre?

Answer 26

Underlying cause, thyroid function, size of goitre, and presence of complications.