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.
- 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.