A 44-year-old woman, with unknown underlying diseases, presented with palpitation for 3 month. She also had significant weight loss (from 65 kgs to 55 kgs in 3 months) and sweating. Her physical examination revealed enlargement of thyroid gland with multiple nodules in both lobes of thyroid gland.

She was sent for investigation and the result is as shown in the picture above.

Questions

1. What is the investigation? and please interpret the results.

Thyroid scan: demonstrate an enlarged gland, especially Lt. lobe of thyroid gland, heterogeous uptake (multi focal hyperfunctioning nodule (hot nodule) and hypofunctioning nodule (cold nodule) within Lt lobe of thyriod gland

2. What is the diagnosis?

Toxic multinodular goiter

3. What is the proper management in this case?

- U/S thyroid gland: Sonographic characteristics of thyroid nodule (cold nodule) +- FNA at thyroid nodule if indicated.

- Definite treatment: Total thyroidectomy or I-131 Ablation

เรียบเรียงโดย อ.นพ.ณัฐพล แก้วประเสริฐ หน่วยต่อมไร้ท่อและเมตะบอลิสม กองอายุรกรรม รพ.ภูมิพลอดุลยเดช กรมแพทย์ทหารอากาศ