Thyroidstimulating hormone free thyroxine triiodothyronine

Note: Results similar to hyperthyroidism can occur with acute psychiatric illness. * Main tests

Thyroid autoantibodies

Raised autoantibodies (antimicrosomal or antithyroid peroxidase) are suggestive of Hashimoto's disease (autoimmune thyroiditis).

Fine needle aspiration

This is the single most cost-effective investigation in the diagnosis of thyroid nodules. It is the best way to assess a nodule for malignancy. Care needs to be taken in the interpretation of the cytology results in conjunction with an experienced cytologist/pathologist.

Thyroid isotope scan

The scan may help in the differential diagnosis of thyroid nodules. A functioning nodule is said to be less likely to be malignant than a nonfunctioning nodule (cyst, colloid nodule, haemorrhage and carcinoma are not functioning).

Thyroid ultrasound

A thyroid ultrasound is usually more sensitive in the detection of thyroid nodules. A multinodular goitre may be diagnosed on ultrasound while the clinical impression may be that of a solitary nodule (the other nodules not being palpable clinically). A multinodular goitre is said to be less likely to be malignant than a solitary thyroid nodule. An ultrasound allows for follow-up of thyroid nodule(s) to note if there are any changes in size over a period of time and to then discuss appropriate intervention with the patient. It can also differentiate a solid from a cystic mass.

High resolution ultrasound is better than CT in assessing glandular texture. CT scan

CT scan of the thyroid may be used particularly to determine if there is significant compression in the neck from a large multinodular goitre with retrosternal extension. Again follow-up CT scans may allow one to determine the progression or otherwise of such a goitre.

Hypothyroidism (myxoedema)

Hypothyroidism, which is relatively common, is more prevalent in elderly women (up to 5%). 2 The term myxoedema refers to the accumulation of mucopolysaccharide in subcutaneous tissues. The early changes are subtle and can be misdiagnosed, especially if only a single symptom is dominant. Patients at risk include:

• previous Graves' disease

autoimmune disorders, e.g. rheumatoid arthritis

Down syndrome

• Turner's syndrome

• drug treatment: lithium, amiodarone

• previous thyroid surgery

• previous radioactive ablation of the thyroid

Hypothyroidism (myxoedema)

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