Endocrine Abstracts

Aim: Establishing the aetiological diagnosis of hyperthyroidism relies on clinical examination, ultrasound imaging and thyroid antibodies; however there is a wide variation in practice in which of the aforementioned approaches are used. The aim of our study was to assess the reliability of clinical examination of thyroid gland in patients with hyperthyroidism, using ultrasound (US) as the reference.

Methods: Case notes and letters of patients of 133 patients with hyperthyroidism referred to endocrine clinic were reviewed. Patients who did not have US were excluded. Data on thyroid anatomy based on clinical examination was collected and compared to US features and clinical diagnosis of the cause of hyperthyroidism.

Results: Size: 82 patients had thyromegaly on US: only 33% of these were documented as having goitre on clinical examination. 51 patients had normal US, 35% of these were documented to have goitre on clinical examination. Nodularity: 54 patients had MNG on US: 30% were reported as normal and further 37% (n=20) were reported as having diffuse enlargement on clinical examination. five patients had solitary nodule on US; four of them were clinically documented as normal. 39 patients had normal US; nine of these patients were reported as thyromegaly and one as solitary nodule on clinical examination. Function: 73 patients had Graves’ disease based on TPO antibody. Based on USA – normal 27%, MNG 33%, solitary nodule 5%, dominant nodule(s) of MNG 5%.

Conclusion: There is significant difference between clinical and US assessment of thyroid gland, with only 47% correlating with each other. 44% of patients with hyperthyroidism could be misdiagnosed as Graves’ disease unless US and/or thyroid antibodies are performed to correlate. A combined diagnostic approach including clinical examination, US and thyroid antibodies may need to be considered in patients with hyperthyroidism to establish aetiology and formulate a management plan.