INVESTIGATIONS OF THYROID LUMPS

INVESTIGATIONS OF THYROID LUMPSThyroid Gland

Thyroid LumpMass in front of the neckDue to enlargement of thyroid glandKnown as GoiterCan be 1- Diffuse 2- Nodular

Causes of thyroid lumpDiffuse: Simple diffuse Auto-immune Thyroiditis Iodine deficiency Goitrogens Dyshormogenesis

Nodular: Solitary Multi-nodular Cystic Fibrotic

Tumours:AdenomasCarcinomasLymphomas

Miscellenous:SarcoidosisTuberculosisClinically, palpable nodules are seen in 4-7% of people.Their incidence increases as age advances. About 5-10% of nodules maybe malignant.Risk of a nodule being malignant increases if the patient received radiation in childhood.Incidence of malignancy increases after 50-60 years of age.

4SymptomsSwelling in the neck: Small or large Asymptomatic or painfulMay compress nearby structures and cause: Airway obstructionDysphagiaCoughing or wheezingHoarseness of voice

The primary symptom of a goiter is noticeable swelling in the neck. The swelling may range in size from very small to very large. This swelling can be asymptomatic or maybe painful. The swelling may compress nearby structures and produce symptoms likedifficulty swallowing (due to compression of the esophagus)Difficulty breathing, Coughing or wheezing (due to compression of the trachea)Hoarseness of voice (due to compression of the Larynx5History The patient may present with :Swelling in the neck: Seen by the patient or on routine physical examReferred as an incidental nodule on imagingAgeDysphagia, stridor, hoarsenessPainChange in size of the lumpSymptoms of hypothyroidism or hyperthyroidismHistory of previous radiation Family history of thyroid cancer Clinically, palpable nodules are seen in 4-7% of people.Their incidence increases as age advances. About 5-10% of nodules maybe malignant.Risk of a nodule being malignant increases if the patient received radiation in childhood.Incidence of malignancy increases after 50-60 years of age.

6ExaminationInspectionPalpationPercussionAuscultation

Palpation of the goiter is performed either facing the patient or from behind the patient, with the neck relaxed and not hyperextended. Palpation of the goiter rules out a pseudogoiter, which is a prominent thyroid seen in individuals who are thin. Each lobe is palpated for size, consistency, nodules, and tenderness. Cervical lymph nodes are then palpated. The oropharynx is visualized for the presence of lingular thyroid tissue. A firm rubbery thyroid gland suggests Hashimoto thyroiditis, and a hard thyroid gland suggests malignancy or Riedel struma.Multiple nodules may suggest a multinodular goiter or Hashimoto thyroiditis. A solitary hard nodule suggests malignancy, whereas a solitary firm nodule may be a thyroid cyst. Diffuse thyroid tenderness suggests subacute thyroiditis, and local thyroid tenderness suggests intranodal hemorrhage or necrosis.Cervical lymph glands are palpated for signs of metastatic thyroid cancer.Auscultation of a soft bruit over the inferior thyroidal artery may be appreciated in a toxic goiter. Palpation of a toxic goiter may reveal a thrill in the profoundly hyperthyroid patient.

7Blood TestsTHYROID FUNCTION TEST: Functional status of thyroid gland Euthyroidism, hypothyroidism or hyperthyroidism Measure serum TSH, free T3 and T4 T3 T4 TSHNormal levels/Euthyroid (2.3-4.2 ng/dL) (0.8-2.8 ng/dL) (0.3-5.0 U/mL)

Primary Hypothyroidism

Secondary Hypothyroidism

Primary Hyperthyroidism

Secondary Hyperthyroidism

Palpable nodules are seen in about 5% of people.About 5-10% of the nodules may be malignantRisk of malignancy increases above age 50-60 yrs, and if the pt received radiation in childhood.The main consideration in a thyroid nodule is to pick up cases of carcinoma8Blood TestsSerum Thyroglobulin:Protein found in thyroid cellsUse: Follow up cases of thyroid Ca after surgeryRef range: 0-30 ng/mL

Thyroglobulin Autoantibodies:Ref range: