Thyroid Swelling

A 48 year old post-menopausal woman with

a diffuse thyroid swelling more than 10 years:

1.Issues to be covered:

• pregnancy,puberty
• where she lives
• any medications:antithyroid,Lithium,Amiodarone
• women in reproductive years or >65
• hard & fixed suggest malignancy
• tenderness in thyroiditis
• Ask hyper/hypo symptoms
• Ask 3Ds:dysphagia,dysphonia,dyspnoea
• When does she first notice the swelling?
• Any past history of irradiation
• Any family history of thyroid cancer,FAP
  

2.Examination

• Inspect the fully extended neck
• Ask to swallow
• Elicit Pemberton’s sign
• Palpate including cervical glands
  
• Auscultation
  

3.Management

• Immediate referral in case of suspected malignancy

• Perform TFTs and follow up to inform about the results

• Hyper:nearly always benign

• Nodule with normal TFT:Ultrasound scan and possible FNAC

REF:

Practice

10-Minute Consultation

Thyroid swellings

BMJ 2009;339:b2563
Published 13 July 2009, doi:10.1136/bmj.b2563