managing a swelling in the thyroid mark lansdown leeds teaching hospitals trust
TRANSCRIPT
This presentation will cover -
• basic revision• difference between diffuse and localised
swellings• taking a good history• investigation by the GP (should they be referred
immediately or can we usefully scan them)• what you do about them• what GP's need to know about after care of
thyroid cancer
Thyroid - basic revision
• first of the body's endocrine glands to develop, at day 24 of gestation
• develops from an endodermal thickening in the midline of the floor of the developing pharynx
• thyroglossal duct is obliterated, the distal part remaining as the pyramidal lobe
• C cells, which produce calcitonin, are of neural crest origin
Thyroid - basic revision 2
• T4 and T3 produced by follicular cells initially as thyroglobulin stored in colloid
• Requires iodine (and selenium)• TSH from anterior pituitary regulates
production of thyroglobulin and release of T4 into circulation
• Active form of thyroxine is T3
Thyroid - basic revision 3
• Thyroxine is essential for normal development and differentiation of probably all tissues of the body
• Act on most cells in the adult affecting metabolism, protein synthesis
• No pathognomonic symptoms of an under or overactive thyroid
Thyroid - difference between diffuse and localised swellings
• Diffuse goitre– Adolescence and pregnancy– Iodine deficiency– Thyroiditis– Early MNG
• Localised Swelling (5% population)– Dominant nodule MNG– Cyst– Adenoma– Carcinoma (5% of all nodules)
Thyroid - taking a good history
• Symptoms and signs of abnormal thyroid function – T4, TSH, TPO
• The “lump”– Since when?, has it changed?, associated symptoms
• Pain• Voice change• Medication
• Family history
Thyroid - investigation by the GP
• T4, TSH– Trends, drifting within the normal range?
• Thyroid peroxidase antibodies (TPO)– An anti-thyroid autoantibody• Present in > 90 % Hashimoto’s thyroiditis• Less commonly raised in Grave’s disease, MNG and
thyroid cancer
Thyroid - investigation by the GP 2
• Thyroid Ultrasound– Not recommended in the pathway for urgent
referrals (2WW) – Highly operator dependent– Often needs to be repeated after referral
• Neck ultrasound– incidentalomas
What GP's need to know about after care of thyroid cancer
• Is thyroid cancer uncommon?– Incidence USA• Breast 125/100,000 women• Thyroid 20/100,000 women (6/100,000 men)
– Prevalence• Breast 3,000,000• Thyroid 600,000
What GP's need to know about after care of thyroid cancer 2
• THS suppression <0.01– Not always necessary in the low risk patient– Risk of side effects• Anxiety, palpitations• Bone health• Cardiac health
What GP's need to know about after care of thyroid cancer 3
• Local Guidelines www.ycn.nhs.uk
• www.amend.org.uk
• www.btf-thyroid.org
• www.thca.org (American)
• www.butterfly.org.uk