Wednesday, 28 May 2008

multinodular goitre

this patient presented with swelling in his neck.please examin.
what are your findings?
what is your diagnosis?
how would investigate this patient?
how would you manage this patient?


  1. this patient has a multinodular goitre and he is clinicaly ? euthyroid (simple multinodular goitre)/hyperthyroid ( toxic multinodular goitre)

  2. the main priority is to exclude malignancy.
    2-thyroid scan:hot vs cold
    3-ultra sound:cystic vs solid
    4-fine needle aspiration
    as a general role:
    if TSH is low or undetectable proceed for thyroid scan
    if TSH is normal, USS and FNA

  3. treatment:
    if hyperthyroid (toxic multinodular):
    1-surgery, only when euthyroid
    2-antithyroid medications:carbimazole, propylthiouracil -/+ beta blocker
    dose titration
    block n replace
    high rate of relapse
    3-radioidine:subsequent hypothyrodism
    contraindicated in pregnancy

    if euthyroid (simple multinodualr goitre):
    surgical intervention might not be needed,however it might be required for:
    cosmotic reasons
    press effect
    possibilty of maliganacy

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