Like other endocrine organs (eg. pituitary gland, parathyroid gland). thyroid diseases generally manifest clinically in TWO main ways.
1. Enlargement (non-neoplastic or neoplastic)
- Determined by history, clinical examination and imaging
2. Abnormal function (hyper- or hypothyroidism)
- Assessed by blood investigations of various hormone levels (free T3 Free T4, TSH)
Remember, these two can co-exist (eg Graves disease - think about what the clinical presentation is).
The aetiology of thyroid conditions is widely variable, but the few that are more common and important are as featured in your lecture notes:
- Congenital conditions (eg. hypoplasia, ectopic thyroid)
- Hyperplasia (simple or nodular hyperplasia due to decreased iodine availability)
- Immune related (autoimmune, or other mechanisms of thyroiditis)
- Neoplasms
In clinicopathologic correlation, we would ask some questions. Eg. What condition is more likely to cause diffuse enlargement? Which causes a solitary nodule?
This mindmap helps summarise the various conditions as the pathology relates to the clinical presentation.
MINDMAP: Clinicopathologic correlates
If you can't play the video, watch it here on YouTube: https://youtu.be/ydSxUx6n7Jk
This screenshot taken from the above mindmap summarises the common conditions causing various types of goitres.
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Hi, with reference to the screenshot of the common conditions causing various types of goitres, may I clarify why Hashimoto’s is parked under non-neoplastic nodular goitres? I had the impression that Hashimoto’s caused a diffuse goitre.
Thank you for raising this excellent question. You are right, Hashimoto thyroiditis often does cause a diffuse goitre and it should have been added to the diffuse enlargement causes as well. In terms of the nodular enlargement, Hashimoto thyroiditis can also cause this, because the enlargement may be asymmetrical or somewhat nodular, leading to this clinical presentation. I will try to update the mindmap in the near future.