A 22-year-old girl comes to see you in the GP surgery. She complains of a month-long history of worsening tremor, palpitations and swelling in the midline of her neck.

Give three possible causes of a lump in the midline of the neck. (3 marks)

Through history and examination, how would you determine the cause of the lump? Give four factors in the history and four in the examination. (4 marks)

You ascertain the lump is most likely thyroid in origin. Name two different types of thyroid lump. (2 marks)

Give three ways you would further investigate the thyroid lump. (3 marks)

Not all thyroid lumps require surgery. Give two indications for surgical removal of the thyroid. (2 marks)

Why is hoarseness of the voice a complication of thyroid surgery? (1 mark)