🦋 Goiter · Thyroid Enlargement · Hyperthyroid vs Hypothyroid Tool

Schwartz Clinical Handbook — Chapter 36 · Hashimoto thyroiditis · Graves disease · Thyroid nodule · Congenital goiter · Suppurative thyroiditis

Select thyroid size, consistency, tenderness, metabolic symptoms (weight, heart rate, temperature preference, energy), and antibodies → differentiate Hashimoto (hypothyroid/euthyroid) from Graves (hyperthyroid) from acute thyroiditis or nodule.
⚠️ Red flags: thyroid nodule with firmness, rapid growth, hoarseness, cervical lymphadenopathy → malignancy risk (FNA biopsy).

📋 Step 1 — Thyroid exam & metabolic clues
📌 Diagnostic impressions
📖 Schwartz Ch 36

Select gland size, nodularity, tenderness, weight changes, heart rate, temperature intolerance, eye signs, and antibody labs → differentiate Hashimoto thyroiditis, Graves disease, acute suppurative thyroiditis, multinodular goiter, or thyroid nodule (benign vs malignant).

✔️ Hashimoto: firm, irregular goiter, euthyroid/hypothyroid, anti‑TPO/anti‑TG positive.
✔️ Graves: diffuse soft goiter, weight loss, tachycardia, exophthalmos, TSI positive.
✔️ Subacute thyroiditis: tender gland, painful, elevated ESR, transient hyperthyroidism.
✔️ Thyroid nodule: ultrasound & FNA if >1 cm or suspicious features.
📘 Schwartz pearls (Chapter 36)
• TSH, free T4, TPO antibodies first line.
• Methimazole for Graves (PTU reserved for thyroid storm).
• Levothyroxine for hypothyroidism (Hashimoto).
• FNA for solid nodules >1 cm or any nodule with concerning features (microcalcifications, irregular margin, hypoechoic).