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Diffuse Goitre: Key Facts (Smooth (Grave’s Disease: ↑ uptake (Features…
Diffuse Goitre: Key Facts
Multinodular
Features
Commonest goitre in UK
Progression of simple diffuse goitre to nodular
enlargement.
Middle-aged women
Positive family Hx
Over-activity in parts may → mild thyrotoxicosis
Plummer’s Syndrome
Malignant change occurs in 5% of untreated MNGs
Mx
Most pts. don’t require intervention
Non-Surgical
Thyroxine
→ regression in 50-70%
Suppress TSH
Toxic Multinodular Goitre
Propranolol + carbimazole
Radioiodine
Surgical
Indications: 5 Ms
Mechanical obstruction
Malignancy
Marred beauty: cosmetic reasons
Medical Rx failure: thyrotoxicosis
Mediastinal extension: can’t monitor changes
Procedure
Total thyroidectomy
Removes risk of malignant change in thyroid
remnant
Smooth
Simple Colloid Goitre
Hyperplasia of gland secondary to ↑TSH release
Causes
Iodine deficiency: commonest worldwide
↑ physiological demand: pregnancy, puberty
Goitrogens: e.g. Li, uncooked cabbage
Rx
Not usually required
Thyroxine or ↑ dietary iodine
Grave’s Disease: ↑ uptake
Epidemiology
Prev: 0.5%
60% of cases of thyrotoxicosis
Sex: F>>M=9:1
Age: 40-60yrs
Features
Diffuse goitre w/ bruit
Triggers: stress, infection, child-birth
Ophthalmopathy
Oedema: periorbital and chemosis
Exophthalmos → exposure keratopathy
Ophthalmoplegia: esp. upgaze palsy
Optic neuropathy: ↓ acuity and RAPD
Dermopathy: pre-tibial myxoedema
Acropachy: periosteal reaction (clubbing is soft tissue)
Pathology of Eye Disease
Exophthalmos
Retro-orbital inflammation and lymphocytic
infiltration → orbital oedema
secondary to anti-TSH abs
Lid-lag
Not Graves’ specific
Sympathetic overstimulation → restrictive
myopathy of LPS
Association
T1DM
Vitiligo
Pernicious anaemia
Rx
Medical: propranolol + carbimazole
Radioiodine
Surgical: subtotal or total thyroidectomy
Thyroiditis: ↓ uptake
Hashimoto’s
de Quervain’s
Subacute lymphocytic: post-partum
Riedel’s
Plummer’s vs. Graves
Plummer’s
Older
Nodular enlargement
No extra features
AF in 40%
No assoc. AI disease
Graves’
Younger
Diffuse enlargement
Extra Features
Eye signs
Dermopathy
Acropachy
AF relatively uncommon
a/w AI disease