A 40-year-old female presents with symptoms of heat intolerance, excessive sweating and weight loss since 10-12 months. After clinical examination, the surgeon orders an investigation which is as shown in the image. The scan shown below is a/an
radionuclide scan
The correct answer is a radionuclide scan (thyroid scintigraphy). Heat intolerance, sweating and weight loss over 10-12 months indicate thyrotoxicosis, and the image is a functional isotope study using technetium-99m pertechnetate (half-life 6 hours, imaged at 20 minutes) or iodine-123/131. Its value is in finding the cause once TSH is suppressed: diffusely increased uptake in both lobes indicates Graves disease, a solitary hot nodule with a suppressed remaining gland indicates toxic adenoma, patchy multiple hot areas indicate toxic multinodular goitre, and near-absent uptake indicates thyroiditis or factitious thyrotoxicosis. It also detects retrosternal, lingual and ectopic thyroid tissue.
MRI and non-contrast CT are purely anatomical: they show size, retrosternal extension and tracheal compression but give no functional information, and iodinated contrast is best avoided in thyrotoxicosis. FDG-PET is an oncological tool for staging or detecting recurrent, iodine-negative thyroid carcinoma with a raised thyroglobulin, not for evaluating hyperthyroidism.
Key point: Function equals radionuclide scan; anatomy equals ultrasound, CT or MRI. A hot nodule is almost never malignant, whereas a cold nodule carries roughly 10-20 percent malignancy risk.
Important Questions from Neck & Breast Surgery
- A midline neck swelling just below the hyoid bone and managed by Sistrunk's operation leads to postoperative need for thyroxine replacement. The most likely diagnosis is
- A 60-year-old lady presents with a recent onset increase in a long standing swelling on the front of the neck. The swelling, which was small, had been present since last 30 years, but has now increased to more than twice the size in the last 2 months. On examination, the swelling is firm to hard in consistency and moves with deglutition. What is the most likely cause of this clinical presentation?
- A 43 year old woman presented with serous discharge from a single duct of the nipple of her right breast which was sent for evaluation. She is unlikely to be suffering from
- Which of the following are included in triple assessment in case of breast?
1. Clinical assessment
2. Radiological assessment
3. Histopathological assessment
4. Sentinel lymph node biopsy
Select the correct answer using the code given below. - A gentleman of 60 years presented with a brawny swelling of the sub- mandibular region with inflammatory oedema of mouth and putrid halitosis. Most likely he is suffering from
