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  1. Rebecca Hatton, clinical research associate1,
  2. Madhukar Patel, general practitioner2,
  3. Devasenan Devendra, community consultant endocrinologist and honorary senior lecturer in medicine3
  1. 1Central Middlesex Hospital, London NW10 7NS
  2. 2Brent Teaching Primary Care Trust, London HA0 4UZ
  3. 3Brent Teaching Primary Care Trust; Central Middlesex Hospital; and Division of Investigative Science, Imperial College, London W12 0NN
  1. Correspondence to: D Devendra d.devendra{at}imperial.ac.uk
  • Accepted 21 May 2008

A 48 year old post-menopausal woman presents with a smooth midline swelling in her neck, which has been present for more than 10 years. On examination, you find that it is consistent with an enlarged thyroid gland.

What issues you should cover

  • A palpable thyroid swelling (defined as a goitre) may be physiological if the patient is pregnant or going through puberty.

  • Patients who have lived in an iodine deficient area (for example, north Pakistan, central Africa, and mountainous areas such as the Andes or Himalayas) are at increased risk of goitre.

  • Lithium, amiodarone and antithyroid drugs (such as carbimazole and propylthiouracil) can predispose to goitre.

  • Thyroid swellings are more likely to be malignant in patients over 65 years or in women during their reproductive years.

  • Common differentials for swellings in the central component of the neck include thyroglossal …

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