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Case 178: Lump in the neck

A 43 year old woman presents with a long history of a slowly enlarging mass in the neck. She nows considers it a cosmetic problem.

1. What is the diagnosis?

Goitrous enlargement of the thyroid. Most likely benign multinodular goitre.

2. What issues in the history would you explore?

Functional state

Family history

Risk of malignancy

3. What investigations would you arrange?

Thyroid function tests - in particular TSH

Thyroid US to assess the nodularity and extent of disease

CT neck is appropriate for large thyoids with intrathoracic extension to allow planning of surgery. Note that iodine based intravenous contrast agents commonly administered during CT scans may precipitate hyperthroidism - the Jod-Basedow phenomenon.