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Clinical investigations from the RACP

Thyroid enlargement: a more direct approach to investigation

Soji Swaraj
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Abstract

Patients routinely undergo a battery of expensive blood tests and imaging modalities when thyroid enlargement is detected but not all of these are necessary initially. A logical care path can reduce costs and provide reassurance for many patients.

Key Points

  • Investigations for thyroid enlargement should be restricted to those that will directly influence management of a particular patient’s problem.
  • Many patients with thyroid enlargement experience significant anxiety. A logical care path provides them with earlier reassurance and also reduces costs.
  • An assay of serum TSH levels should be on the list of initial investigations for all patients presenting with thyroid enlargement.
  • Ultrasonography should not be the first investigation for a patient presenting with thyroid enlargement, but it does have management value in certain situations.
  • Asymptomatic patients with a diffuse goitre who are clinically and biochemically euthyroid can be spared imaging and antibody assays altogether. Many can be managed with reassurance and follow up, including annual TSH measurement.
  • Suppressive treatment with thyroxine is effective in reducing the size of some diffuse, nontoxic goitres. However, its value in multinodular goitres is questionable.

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