"I have a thyroid swelling. What will my doctor do?"

The first question that comes to the physician’s and patient’s mind is whether a goitre is benign or malignant. An overactive thyroid is very rarely malignant, so in clinical practice when we see a patient with a goitre and hyperthyroidism we do not think of cancer. A patient with a thyroid cancer would be mostly euthyroid. Fine needle aspiration cytology (FNAC) is helpful to make a diagnosis of thyroid cancer3 (Fig.8).

We need to remember very clearly that FNAC can be falsely positive or falsely negative in a significant number of cases and should be correlated with clinical picture.

Fig. 8 - FNAC of a goitre showing cancer cells (Papillary Carcinoma).

"Clinical clues for Graves' disease are thyroid ophthalmopathy (infiltrative eye disease, only stare is not good enough to make a diagnosis of Graves' ophthalmopathy), infiltrative dermatopathy (the deposition of chondroitin sulphate and hyaluronic acid in the dermis which are hydrophilic in nature causing retention of water) (Fig.9).

Fig 9. Graves’ Opthalmopathy and Pretibial Myxaedema

Presence of features suggestive of other autoimmune diseases like vitiligo, Addison’s disease would point to an autoimmune thyroid disease (AITD) (Fig.10).

Fig. 10 - Polyglandular Autoimmune Syndrome - Clinicalphotograph showing a man with Graves’ disease, Addison’s disease (hyperpigmentation) and Vitiligo

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