Presentations
- Asymptomatic biochemical findings
- Compressive symptoms
- Goitre
- Hoarse voice/stridor
- Neck lump
- Pretibial myxoedema
- Symptomatic hyperthyroidism
- Symptomatic hypothyroidism
- Thyroid eye disease
Conditions
- Benign thyroid nodule(s)
- Hyperthyroidism:
- central (TSHoma)
- Graves disease
- medication-induced (e.g. amiodarone)
- thyroiditis
- toxic multinodular goitre
- toxic nodule
- Hypothyroidism
- autoimmune (Hashimotos thyroiditis)
- central (pituitary)
- granulomatous thyroiditis
- iodine deficiency
- medication induced
- painless thyroiditis
- post-surgical
- suppurative thyroiditis
- Perioperative management of patients with thyroid disease
- Syndromes of resistance to thyroid hormones (alpha, beta)
- Thyroid cancer:
- anaplastic
- follicular
- Hurthle
- lymphoma
- medullary
- metastases to thyroid
- papillary
- poorly differentiated/insular
- Thyroid disorders in pregnancy and postpartum:
- Graves disease
- hypothyroidism
- postpartum thyroiditis
- thyroid cancer
- transient hyperthyroidism of pregnancy
- Thyroid eye disease
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
- suppurative thyroiditis
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
- Risk factors for thyroid disease:
- concurrent autoimmune disorders
- exposure to high iodine loads – dietary or medical
- exposure to ionising radiation:
- childhood malignancy
- employment
- environmental
- head and neck cancer
- family history
- medications used to treat other conditions such as malignancy, such as:
- amiodarone
- biological agents (including immunotherapies)
- lithium
- smoking
Investigations
- Biochemical evaluation of the hypothalamic-pituitary-thyroid axis including:
- thyroid autoantibodies
- thyroid function (FT4 and FT3)
- tumour markers
- Differences between primary and secondary hypothyroidism and differences in thyroid function on replacement in primary and secondary hypothyroidism
- Imaging:
- CT scans – neck and thorax
- nuclear medicine uptake scanning (Technetium 99, I123 and I131)
- PET scans
- thyroid ultrasound
- Surveillance of thyroid cancer and appropriate dosing of thyroxine
- TIRADS risk stratification of nodules, the risk of malignancy with each category and knowledge of surveillance/biopsy recommendations
Referrals for procedures
- Radioactive iodine code recommendations for:
- ablative doses (including use of recombinant TSH or thyroid hormone withdrawal)
- Graves disease
- low dose scans
- thyroid cancer therapeutic
- toxic nodule
- Hemithyroidectomy versus total thyroidectomy
- Hot nodule(s), MNG and thyroid cancer
- Indications for surgery
- Interpretation of cytology:
- Bethesda scoring system
- genetic testing
- Risks, indications and contraindications, such as:
- lactation
- pregnancy
- thyroid eye disease
- Thyroid nodule FNA
- Thyroid surgery
Procedures (optional)
- Fine needle aspiration biopsy of thyroid nodules
- Thyroid ultrasound
- Apply the general principles of triage according to clinical presentation
- Work with colleagues in nuclear medicine, thyroid surgery, obstetrics, pharmacy, chemical pathology, histopathology and other doctors to deliver multidisciplinary input to patient care, as applicable to each case, and participate in multidisciplinary team meeting discussions for thyroid cancer
Management of common thyroid conditions
- Adjust thyroid replacement medication, and screen for other autoimmune disease annually
- Adjust anti-thyroid medication, and show awareness of complications of thionamides
- Management following thyroid cancer, including thyroid replacement and surveillance for thyroid cancer recurrence, and understand the indications and role of chemotherapy agents
