Background: Toxic thyroid nodules are difficult to manage medically. Surgical versus radioiodine therapy can be chosen in light of risk and benefit for individual cases.
Clinical case: 72 years old woman presented with 3 months history of hands tremor. There was no associated palpitations, weight loss, sweating, diarrhoea or mood change. She reported mild tiredness. She had never noticed any lump or pain in her neck. There was history of cold intolerance which had been a long standing problem and did not change recently. Her thyroid function was tested and showed fT4 of 25.4 (1222 pmol/l) with suppressed TSH <0.01 (0.274.2 mU/l). She was started on carbimazole 5 mg daily by her GP and was referred to the Endocrine clinic. On treatment her tremors improved but did not settle completely. Clinically she was euthyroid. Her heart rate was 80/minute and regular. There was no tremor or sweaty palms. There was no evidence of thyroid eye disease. Thyroid gland was not enlarged. The rest of systemic examination was unremarkable. Her repeated thyroid function on carbimazole showed TSH of 0.02 (0.274.2 mU/l) and FT4 12 (1222 pmol/l). Her TSH receptor antibodies and thyroid peroxidase antibodies were negative. Thyroid uptake scan was performed to evaluate the cause of hyperthyroidism which showed localised increased uptake consistent with a solitary toxic nodule. Definitive treatment of her toxic nodule in form of surgery or radioiodine treatment was discussed with patient and she opted for surgery.
Conclusion: For solitary thyrotoxic nodules, surgical approach can be considered a better management option as it would preserve thyroid function but decision is dependant on patients preference.
16 - 18 Apr 2018
Society for Endocrinology