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Toxic multinodular goitre — SCE Endocrinology MCQ

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EasyThyroidToxic multinodular goitreSCE Endocrinology

A 68-year-old woman has atrial fibrillation, weight loss and a nodular goitre. TSH is <0.01 mU/L, free T4 is 29 pmol/L and TSH receptor antibodies are negative. Thyroid uptake scan shows patchy increased uptake in multiple nodules. What is the most likely diagnosis?

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Correct answer: A — Toxic multinodular goitre

Patchy uptake in multiple nodules with negative TSH receptor antibodies supports toxic multinodular goitre. Graves' disease typically has diffuse increased uptake and positive antibodies. The pearl is that the uptake scan is most useful when antibody status and gland morphology point away from Graves'.

Reference: NICE NG145