Table of Contents Most common causes in the UKClassification of possible causes Investigations ManagementComplicationsHere are some questions for youTry some thyroid stations A goitre is the term used for an enlarged thyroid gland. Goitre Most common causes in the UK Graves’ diseaseMultinodular goitre (NB: a multinodular is an ultrasound diagnosis because they usually feel smooth or only slightly irregular) Physiological goitre (pregnancy/puberty) Classification of possible causes DiffuseSimple = euthyroid gland enlargement without inflammation or cancer (e.g. physiological, iodine deficiency)Autoimmune (e.g. Graves’ disease, Hashimoto’s thyroiditis)Infective (e.g. acute viral/De Quervain’s thyroiditis) – painfulIatrogenic (e.g. lithium, amiodarone)NodularMultinodular goitre (euthyroid)Toxic multinodular goitre (hyperthyroid)Solitary nodule (e.g. cancer, adenoma, cysts) Investigations Thyroid function testsThyroid autoantibodies: TSH-receptor antibodies, thyroid peroxidase antibodies, thyroglobulin antibodiesImagingUltrasoundRadioiodine uptake scanCT (if retrosternal)Ultrasound-guided fine needle aspiration Management Conservative: if patient is euthyroid, reassureMedical: make patient euthyroidHyperthyroid: β-blocker (symptomatic), carbimazole (thyroid peroxidase inhibitor), radioiodine-131 therapyHypothyroid: thyroxineSurgical thyroidectomy/resection if:MalignantCompression of surrounding structures CosmeticAlternative option for treating hyperthyroidism Complications Hyper/hypothyroidismCompression of surrounding structuresCosmetic issues Here are some questions for you Which surrounding structures may a large goitre compress? Which symptoms would result? Oops! This section is restricted to members. What is Pemberton sign? Oops! This section is restricted to members. Try some thyroid stations Thyroid examGraves’ diseaseHashimoto’s thyroiditisFind more OSCE stations here