Presentations
- Asymptomatic incidental findings on blood tests or imaging detected on screening or routine surveillance
- Compressive symptoms
- Goitre
- Neck lump
- Ophthalmopathy:
- Systemic symptoms, such as:
- altered bowel habit
- altered mood
- fatigue
- gastrointestinal tract disturbance
- menstrual disturbance
- neonatal jaundice
- palpitations
- poor growth
- precocious puberty
- tachycardia
- tremor
- weight change
Conditions
- Graves ophthalmopathy
- Hyperthyroidism:
- autoimmune:
- Graves disease
- hashitoxicosis
- hot nodule
- medication-induced
- neonatal
- thyroiditis
- Hypothyroidism:
- autoimmune (Hashimoto disease)
- central (pituitary)
- congenital / neonatal
- hypothyroxinaemia of prematurity
- medication-induced
- thyroiditis
- Iodine deficiency
- Perioperative management of patients with thyroid disease
- Thyroid hormone resistance:
- thyroid hormone cell membrane transport defects (MCTB)
- thyroid hormone receptor defects (THRB, THRA)
- Thyroid cancer:
- Thyroid nodule(s):
- benign
- functioning
- malignant
- non-functioning
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Advanced or recurrent thyroid cancer
- Thyroid emergencies:
- complications from anti-thyroid medications:
- agranulocytosis
- hepatitis
- critically unwell patients presenting with concurrent thyroid derangement
- patients presenting with myxoedema coma
- patients presenting with, or at risk of, thyroid storm
- Van Wyk-Grumbach syndrome
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Causes of hypothyroidism during and beyond the newborn period
- Causes of permanent thyroid dysfunction in term and pre-term infants
- Causes of transient hyper- and hypothyroidism in term and pre-term infants
- Differences in thyroid function between premature and term infants
- Regulation of iodine homeostasis and iodine deficiency
- Risk factors for malignant thyroid disease, particularly radiation exposure
- Risk factors for thyroid disease:
- concurrent autoimmune disorders, such as autoimmune polyglandular syndrome type 1 or 2
- family history
- medications, such as:
- amiodarone
- biological agents used to treat other conditions, such as malignancy
- lithium
- Thyroid autoimmunity
- Thyroid hormone resistance and its clinical consequences
- Thyroid replacement therapy and clinical follow-up in infants with congenital hypothyroidism
Investigations
- Anti-thyroid medication and complications
- Biochemical evaluation of the hypothalamic-pituitary-thyroid axis
- Genetic testing for causes of congenital hypothyroidism, such as:
- dyshomonogenesis
- iodothyronine transporter defects
- Pendred syndrome
- thyroid dysgenesis
- thyroid hormone resistance
- Imaging:
- nuclear medicine uptake scanning
- staging imaging (CT / MRI) in patients with malignant thyroid disease
- thyroid ultrasound
- TIRADS risk stratification of nodules
- Laboratory investigation of iodine deficiency
- Newborn screening for hypothyroidism
- Thyroid and bone age imaging in term and pre-term infants
- Thyroid function tests
- Thyroid replacement medication
- Whole body radioiodine uptake
Referrals for procedures
- Radioactive iodine (RAI):
- Graves disease
- hot nodule(s), MNG, and thyroid cancer
- risks, indications and contraindications, such as:
- pregnancy
- radiation exposure risk for pregnancy and young children
- thyroid eye disease
- Role of radio-iodine therapy in malignant thyroid disease
- Thyroid nodule FNA (interpretation of histology)
- Thyroid surgery when clinically appropriate
- Effects of non-thyroidal illness, particularly severe illness, on thyroid function and thyroid function tests
- Emerging role of precision medicine and targeted treatments in childhood cancer
- General principles of triage according to clinical presentation
- Genetic causes of congenital hypothyroidism
- Genetic counselling
- Long-term follow-up of children with thyroid carcinoma, including risk of recurrence, monitoring, and risk of second malignancies
- Long-term management of children following treatment for malignant thyroid disease, including thyroid-stimulating hormone (TSH) suppression, use of thyroglobulin, and monitoring for recurrence
- Refer appropriately to endocrine surgeons and nuclear medicine specialists
- Work with colleagues in chemical pathology, histopathology, nuclear medicine, obstetrics, pharmacy, thyroid surgery, and other doctors to deliver multidisciplinary input to patient care, as applicable to each case
