Toxic multinodular goitre — SCE Endocrinology MCQ

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ModerateThyroidToxic multinodular goitreSCE Endocrinology

A 71-year-old woman has atrial fibrillation and weight loss. TSH is <0.01 mU/L, free T4 is 24 pmol/L and examination reveals an irregular nodular goitre. TSH receptor antibody is negative. What is the most appropriate next investigation?

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Correct answer: C — Radionuclide thyroid uptake scan

In antibody-negative thyrotoxicosis with nodular goitre, radionuclide uptake helps distinguish toxic multinodular goitre from thyroiditis or other causes. Pituitary MRI is inappropriate with suppressed TSH. Calcitonin is used in selected nodule assessment contexts, not as the first test for this biochemical picture.

Reference: NICE NG145; BNF