Toxic multinodular goitre — SCE Endocrinology MCQ

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ModerateThyroidToxic multinodular goitreSCE Endocrinology

A 67-year-old man has persistent subclinical hyperthyroidism discovered during atrial fibrillation assessment. TSH is <0.01 mU/L on repeat testing, free T4 and free T3 are normal and thyroid scan shows patchy uptake in a nodular gland. What is the most appropriate management?

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Correct answer: E — Discuss definitive treatment such as radioiodine for toxic multinodular goitre

Discuss definitive treatment such as radioiodine for toxic multinodular goitre is best because fully suppressed TSH in an older patient with atrial fibrillation risk and nodular autonomy warrants specialist-directed definitive treatment discussion. The alternatives are less appropriate because levothyroxine worsens suppression; discharge ignores risk; carbimazole controls but is rarely definitive; pituitary MRI is not indicated with suppressed TSH. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG145; British Thyroid Association guidance