Razel Joy asked 1 year ago

How to investigate a nodular goitre?

1 Answers
Rishad Staff answered 1 year ago
  1. Serum thyroid-stimulating hormone (TSH) and free thyroxine (T4) should be measured to identify those with subclinical or overt hyperthyroidism. If the TSH is suppressed, radionuclide scanning should be performed.
  2. Ultrasonography of the thyroid gland indicates whether goitre is cystic or solid:
    • If solid, perform a radioisotope scan to indicate hot or cold
    • If cold nodule, fine-needle aspiration.
  3. Patients with features of tracheal compression (inspiratory stridor and dyspnoea) should undergo CT or MRI of the neck and upper thorax, pulmonary function tests especially flow volume loop studies. When CT is used, iodinated contrast agents should not be given because of the risk of inducing hyperthyroidism.
  4. Antibodies against thyroglobulin (AbTG), anti-thyroperoxidase antibodies (AbTPOs) and calcitonin.
  5. If the patient has a family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2, the serum calcitonin level should also be checked.