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Investigations in endocrinology

Investigating a thyroid lump

Emma Scott, Jack Wall

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Abstract

Four case scenarios illustrate the selection and interpretation of investigations to diagnose benign and malignant thyroid lumps.

Key Points

  • Thyroid nodules are common.
  • Investigation requires clinical assessment, thyroid function tests and ultrasonography.
  • Use of fine needle aspiration biopsy is guided by clinical and ultrasound-based suspicion of malignancy.
  • If the patient is hyperthyroid (low serum TSH [thyroid stimulating hormone] level) then a thyroid radionuclide uptake scan is indicated.
  • Thyroid cytopathology drives further surgical or nonsurgical management.
  • Radioactive iodine ablation is undertaken when the patient is in a hypothyroid state or after thyrotrophin-alfa administration.
  • Serum thyroglobulin level is used to monitor disease recurrence.
  • Thyroid cancer prevalence may be increased in autoimmune thyroid disease.

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