(published in the Indian Journal of Endocrine Surgery)


All patients with thyromegaly should have Three Diagnosis.

1.Anatomical Diagnosis
2.Physiological Diagnosis
3.Pathological diagnosis


A complete diagnosis of Thyromegaly should have one from each clause. It can be a combination of any.

Investigations for Thyromegaly
(A) To confirm the Anatomical Diagnosis:
  1. Ultrasonogram of Neck
  2. Tc99 Scan
  3. I131 Scan
2&3 will show not only the Anatomy but also the Physiology of the nodule in question

(B) To Confirm the Physiological Diagnosis:

  1. Serum T3, T4, TSH
  2. Thyroid Antibody
  3. Radio Active Iodine Uptake

Increased RAIU confirms Hyperthyroidism except in Dyshormonogenetic Goitre. RAIU is useful to differentiate toxic phase of thyroiditis from thyrotoxicosis. In toxic phase of thyroiditis since the hypothalamo pituitary thyroid axis is intact RAIU will be very low.

(C) To confirm the Pathological Diagnosis:

  1. Fine Needle Aspiration Cytology
  2. IDL Scopy ( Vocal cord paralysis is an indirect evidence of malignancy)
Treatment for Thyromegaly

(A) For Anatomical problems:

  1. Solitary Nodule + Benign = Hemithyroidectomy
  2. B) For Physiological Problems:

(1) Hypothyroidism + Diffuse Goitre = elevated TSH is the cause for the goitre.Hence, suppress TSH with Thyroxine

(2) Hyperthyroidism + Diffuse Goitre = Anti thyroid drugs or I131 treatment

(3) Hyperthyroidism + Multinodular Goitre = Anti thyroid drugs + Near total Thyroidectomy

(4)Hypothyroidism + Multinodular Goitre = Thyroxine + Near total thyroidectomy.

(C) For Pathological Problems:

For all Malignancies whether they are Solitary nodule or Multinodular Goitre or Diffuse Goitre the only treatment is Total Thyroidectomy.

Remember
Anatomy,Physiology and Pathology.
Go ahead confidently treating cases with Thyromegaly.

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