Toxic thyroid adenoma — SCE Endocrinology MCQ

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HardThyroidToxic thyroid adenomaSCE Endocrinology

A 66-year-old woman with atrial fibrillation has TSH <0.01 mU/L, free T4 23 pmol/L and free T3 9.8 pmol/L. Thyroid uptake scan shows a single hot nodule with suppressed uptake elsewhere. She has no thyroid eye disease. What is the most appropriate management?

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Correct answer: B — Radioiodine treatment after symptom control with beta-blockade

Radioiodine treatment after symptom control with beta-blockade is best because toxic adenoma with overt thyrotoxicosis is commonly treated definitively with radioiodine after controlling symptoms. The alternatives are less appropriate because levothyroxine suppression worsens disease; observation ignores atrial fibrillation risk; glucocorticoids are not definitive; uncontrolled surgery risks thyroid storm. 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