Approach to Thyroid Diseases

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APPROACH TO THYROID DISEASES

Basically how the approach would be depends on the way patients present.

Common presentation is in the form of anterior neck swelling - GOITRE

#What is the definition of goitre?

  It means any swelling of the thyroid and does not imply any particular pathological change.

#Now a patient presents with a goitre!

Few questions need to be answered.

  Is it a diffuse giotre?

  Is it a multinodular goitre?

*If multinodular ± check for any evidence of a dominant nodule which might suggest malignancy.

  OR Is it a solitary nodule?

  Is there any retrosternal extension of the goitre?

  What about presence of enlarged neck nodes

  Any sudden rapid enlargement of the goitre?

  Any significant voice change recently?

  Any difficulty in breathing noted?

  Any problem in swallowing?

  Any associated pain reported?

Another question that need to be answered is;

  Whether patient is Euthyroid? Or Hyperthyroid? Or Hypothyroid?

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3)  Biopsy

  Histological studies confirm the actual diagnosis of the disease

  FNAC ± quite helpful but not always correct

  Core biopsy ± not advisable due to complications

  Histopathological diagnosis ( paraffin section ) is the most reliable

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Notes:

Goitre is a clinical diagnosis

All goitres need pathological diagnosis

The most practical imaging investigation is USS

The definitive investigation of a solitary thyroid nodule is FNAC

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Thyroid Examination - IPPA

Inspection;

  To ascertain that the swelling is a thyroid ± it should move upward when the patient

swallows.  It is also important to observe the patient in general , whether he/she look restless, could

not stay still, anxious , talkative, wearing thick or thin see through clothings.

  Is the patient thin or fat?

  Observe while swallowing

Palpation:

  Palpate the lower border while swallowing

  Feel for the trachea

 Palpate the gland (from behind)

  Palpate the cervical lymph nodes

  Anterior and posterior triangle

Percussion:

  Percuss the sternal region to check for any clinical evidence of retrosternal extension

Auscultate:

  Palpate for the carotid pulses

  Listen to carotid bruit, thyroid bruit

Examine the hands for tremors , sweating

Check the pulse rate ± is it tachycardic?

Look for the eye signs of Thyrotoxicosis

1)  Lid lag

2)  Lid retraction

3)  Exophthalmos

!!A Normal Thyroid Gland is non-palapable!!