Referral pathway with unexplained thyroid lump?
Urgent referral (<2 weeks) for patients of any age
Primary tumours of the thyroid? (5)
Papillary (commonest) Follicular Lymphoma Anaplastic Medullary
Thyroid lymphoma is associated with which other thyroid condition?
Hashimoto’s thyroiditis
Thyroid cancer with worst prognosis?
Anaplastic
Thyroid cancer associated with familial incidence + adenomas elsewhere?
Medullary
Commonest thyroid malignancy and age range commonly affected?
Papillary; around 10-40, commoner in female
Benign thyroid lesions? (3)
Thyroid cyst
Thyroid adenoma
Discrete nodule within a nodular goitre
Five main types of goitre?
Congenital Physiological Nodular Toxic Inflammatory
When might a physiological goitre arise? (3)
Puberty
Pregnancy
Iodine deficiency
Cause of toxic goitre?
Grave’s disease
Causes of inflammatory goitres (thyroiditis)?
Hashimoto’s
de Quervain’s
Riedel’s
Acutely swollen, tender thyroid with transient thyrotoxicosis
de Quervain’s
Thyroid becomes infiltrates with scar tissue +/- hypothyroidism +/- RLN palsy +/- stridor
Riedel’s thyroiditis
Starting dose and monitoring of levothyrooxine?
a) <65 and healthy
b) >65 or pre-existing cardiac disease
a) 50-100 mcg, re-check after 4 weeks and adjust to keep TSH in normal range
b) 25mcg and increase every 4-6 weeks as per TFTs
Management of hyperthyroidism while awaiting specialist review?
Carbimazole/propylthiouracil
Propranolol may be helpful for symptom control
First-line specialist treatment of hyperthyroidism caused by Grave’s or toxic nodular goitre?
Radioactive iodine
Adverse effects of carbimazole? (5)
Agranulocytosis Hepatitis Aplastic anaemia Lupus-like syndromes Pancreatitis
How long does it take for the effects of radioactive iodine to become apparent?
3-4 months
Management of thyrotoxicosis in pregnancy?
Propylthiouracil in 1st trimester, switching back to carbimazole in 2nd trimester. Aim to keep free T4 in upper third of normal range
Management of hypothyroidism in pregnancy?
Increase dose of thyroxine often needed as early as 4-6 weeks