Thyroid nodules

Question 1

define thyroid nodules?

Answer 1

abnormal growth of thyroid cells that forms lump in thyroid gland

Question 2

outline the aetiology/ risk

Answer 2

• most are BENIGN, but a small proportion turn into thyroid cancer
• Most thyroid nodules are adenomatous and most are multiple
• The nodules are usually non-functioning

Question 3

summarise the epidemiology of thyroid nodules?

Answer 3

• 40% of the general population have a single nodule or multiple nodules
• More common in WOMEN

Very small proportion of thyroid nodules will be malignant

Question 4

what are the presenting symptoms of thyroid nodules?

Answer 4

• Most are ASYMPTOMATIC
• Usually found on self-examination or clinical examination

• A single isolated nodule is more likely to be malignant
They can sometimes cause pain and will rarely compress the trachea or cause dysphagia

Question 5

what are the signs of thyroid nodules on physical examination?

Answer 5

• Ask the patient to drink some water and see if the nodule moves when swallowing
• Check for regional lymphadenopathy (consider malignancy)

Question 6

what are the appropriate investigations for thyroid nodules?

Answer 6

• TFTs - most patients will be euthyroid (normal functioning thyroid)
• Ultrasound - useful for determining the character of the thyroid nodules
• FNA - allows cytological analysis

• Radionuclide Isotope Scanning - checks iodine uptake
CT/MRI - detect spread of thyroid cancer

Question 7

what is a mulitnodular goitre?

Answer 7

middle aged women, dysphagia, bumpy swelling, usually euthyroid but some cases a nodule can become autonomous and become a thyroxine-secreting adenoma (hyperthyroidism features)