Goitres

Question 1

What is a goitre?

Answer 1

Enlarged thyroid gland

Question 2

What are the red flags of a goitre?

Answer 2

•	Growth over several months
•	Dysphagia – decompression symptoms
•	Neck pain
•	Hoarseness or aphonia (loss of voice)
      Recurrent laryngeal nerve palsy
•	Hx of radiation exposure to the neck
•	Family Hx of thyroid cancer

Question 3

What produces a diffuse smooth goitre?

Answer 3

o	Grave’s disease
o	Hypothyroidism (hasimoto’s)
o	Thyroiditis
o	Iodine deficiency
o	Drugs – lithium and amiodarone

Question 4

What produces a nodular goitre?

Answer 4

o	Multinodular
o	Single nodule:
      Cyst
      Adenoma
      Cancerous tumour

Question 5

How would you investigate a goitre?

Answer 5

• US followed by fine needle aspiration (FNA) of the lump

Question 6

What are the diagnostic stages of a thyroid cancer?

Answer 6

• Non-diagnostic: Thy1
• Benign: Thy2
• Indeterminate: Thy3
• Suspicious of malignancy: Thy4
• Diagnostic of malignancy: Thy5

Question 7

What are the 2 most common thyroid carinomas?

Answer 7

• Papillary 70%

- Follicular 20%

Question 8

Where do papillary carcinomas commonly metastasise to?

Answer 8

Local lymph nodes in neck

Question 9

Where are papillary and follicular carcinomas derived from?

Answer 9

Follicular epitheliem

Question 10

How would you treat a thyroid cancer?

Answer 10

• Surgery (total thyroidectomy or lobectomy)
• Post-operative radioactive iodine treatment
• Thyroid hormone suppression
Suppresses TSH so tumour growth is not stimulated