Solitary Thyroid Nodule Aisha Abu Rashed

Slides:



Advertisements
Similar presentations
WHO SHOULD BE TESTED FOR THYROID DYSFUNCTION? Groups with an increased likelihood of thyroid dysfunction Previous thyroid disease or surgery Goitre.
Advertisements

Stanley A. Tan MD, MS, MPH, PhD, DTM&H, FACE, FACC, FCCP
APPROACH TO A CASE OF THYROID NODULE
1 Thyroid Function Tests 1.TSH (normal range mU/L) 2.Free T4 (normal range ng/dL) 3.Free T3 (normal range pg/dL)
THYROID DISEASE NODULES AND NEOPLASMS By: Christine B. Taylor, MD.
Thyroid nodules - medical and surgical management JRE DavisNR Parrott Endocrinology and Endocrine Surgery Manchester Royal Infirmary.
Thyroid disease By Dr Fahad.
D3 Tambal – Tolentino THYROID CA.
Thyroid nodule History History Physical examination Physical examination –Euthyroid –Hypothyroid –Hyperthyroid Labs Labs –TSH –(antibodies)
Update in the Management of Thyroid Neoplasms University of Washington
Implementing Guidelines For Thyroid Nodules
THYROID GLAND Begashaw M (MD). Anatomy Anatomy.
Copyright © 2005, Duke Internal Medicine Residency Curriculum and DHTS Technology Education Services Duke Internal Medicine Residency Curriculum Approach.
Chief’s Morning Report October 4, HPI: 57 yo female presents to clinic with a h/o DM, HTN for new patient visit. Pt has no complaints.
Thyroid Nodules & Cancer
THYROID GLAND.
Thyroid Cancer. Thyroid Cancer What is The Thyrid Gland? The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the.
Vic V. Vernenkar, D.O. St. Barnabas Hospital Department of Surgery
Thyroid Stuff Cytopathology & Pathology Ryan Orosco Sept 2013.
THYROID TREATMENT AND VITAMIN D UPDATE A CPMC Regional CME Event - An Integrated Approach Saturday October 27, 2012.
Solitary thyroid nodule Hystory Low dose radiation Family hystory Physical exam.
ד"ר חגי מזא"ה כירורגיה אנדוקרינית מבואות כירורגיה שנה ד'
Approach to a thyroid nodule
Approach to the Thyroid Nodule
2010  Solitary thyroid nodules are present in approximately 4 percent of the population.  Thyroid cancer has a much lower incidence of 40 new cases.
By Dr Fahad albadr MD CHAIRMAN OF RADIOLOGY
Management of the Thyroid Nodule Neil S Tolley MD FRCS DLO St Mary’s Hospital 28 th February 2002.
Subclincal Thyroid Disease and the Work-up of a Thyroid Nodule
Thyroid Nodules Hollis Moye Ray, MD SEAHEC Internal Medicine June 3, 2011.
Causes Thyroid swelling:  Hyperthyroidism.  Hypothyroidism.  Non – toxic goitre.  Auto – immune thyroid disease.  Thyroiditis both local and chronic.
Endocrine Pathology Lab
Managing a swelling in the thyroid Mark Lansdown Leeds Teaching Hospitals Trust.
IMAGING OF THE THYROID Dr Jill Hunt Consultant Radiologist West Herts NHS Trust.
Evaluation of Thyroid Nodules and Abnormal TFT’s Michael L. Tuggy, MD Swedish Family Medicine, Seattle, WA.
Evaluation of Thyroid Nodules
Primary hyperparathyroidism Surgical Approach Dr Mohammad AlShehri, Can. Board, FACS, D Med Edu. Professor of Surgery.
MRCS teaching 01 September 2015
NECK MASSES.
Adult Medical-Surgical Nursing Endocrine Module: Goitre.
Case scenarios- Neck Swelling
3. What work ups are needed, if any?
Question No.1 If you were the physician who initially saw the patient four years ago, what would you have done?
Anterior Neck Mass Case 1 Navarro – Ng 3-C. HISTORY OF PRESENT ILLNESS: – 7 Years Ago She noted an enlarging left anterior neck mass – 1 Year Ago Easy.
Approach to a thyroid nodule
1. Clinical Impression? Differentials?. Thyroid Carcinoma commonly manifests as a painless, palpable, solitary thyroid nodule The patient's age at presentation.
Thyroid disease By Dr Fahad.
Journal Club Elastography: New Development in Ultrasound for Predicting Malignancy in Thyroid Nodules T. Rago, F. Santini, M. Scutari, A. Pinchera,
Anterior neck Extending from the level of C5 - T1 Overlays 2 nd – 4 th tracheal rings Anterior neck Extending from the level of C5 - T1 Overlays 2 nd.
Neck Masses Mohammed Mazhar Beddawi Raed Zakaria Al Bog Ahmmed Zaid Al Sabag.
Management of thyroid nodule.  Introduction.  Guidelines recommendation.  Thyroid nodule work up.  Medical therapy in thyroid nodule  Thyroid nodule.
Oncology 2016 Mark D. Browning, M.D. ’77 Thyroid & Gastric Cancer
What is your clinical impression? What are the differential diagnosis?
Thyroid Nodules ENDOCRINOLOGY DIVISION Dr. HAKIMI, SpAK Dr. MELDA DELIANA, SpAK Dr. SISKA MAYASARI LUBIS, SpA.
Thyroiditis refers to several disorders that cause an inflammation of the thyroid, a gland located in the front of your neck below your Adam's apple. The.
Pathology of thyroid 3 Dr: Salah Ahmed. Follicular adenoma - are benign neoplasms derived from follicular epithelium - are usually solitary - the majority.
The Natural History of Benign Thyroid Nodules JAMA. 2015;313(9): doi: /jama Modulator Prof. 전숙 / R1 윤수진.
Evaluation of Thyroid Nodule with US and FNA

Dr. Usha Sarma, Asstt. Professor, Dr. U. C. Dutta, Prof & Head, Pathology Deptt Gauhati Medical College FNAC of Thyroid Lesion 5 Years retrospective study.
Dr Amit Gupta Associate Professor Dept of Surgery
Management of Thyroid Nodules Detected at US: Society of Radiologists in Ultrasound Consensus Conference Statement Radiology 2005; 237: Presented.
Prevalence of Hot Thyroid Nodules Suspicious for Malignancy
Thyroid Nodule Case Studies
Evaluating Thyroid Nodules in 5 min
COmmon Neck swellings Dr Mohammad AlShehri, Can. Board, FACS, D Med Edu. Professor of Surgery.
NECK MASSES.
MEDULLARY THYROID CANCER
Solitary thyroid nodule approach
Thyroid Disease Nodules and Neoplasms By: Christine B. Taylor, MD.
Presentation transcript:

Solitary Thyroid Nodule Aisha Abu Rashed

Differential Diagnosis • Colloid cyst • Hyperplastic nodule • Follicular adenoma • Papillary carcinoma • Follicular carcinoma • Medullary cell carcinoma • Anaplastic carcinoma • Lymphoma • Metastasis

Risk Factor For Malignancy:**** Hx head/neck irradiation Family Hx of thyroid cancer Age < 20 or> 70 years Male Growing nodule (if the rate of growth is rapid, you must rule out a thyroid lymphoma) Firm or hard consistency Lymphadenopathy Fixed Symptoms of compression in a patient without comorbid goiter: dysphonia, dysphagia, and cough U/S features: microcalcifications, marked hypoechogenicity, irregular margins, absence of Hypoechoic halo around the nodule, lymphadenopathy,

Palpable thyroid nodules occur in 4–8% of adult women and 1–2% of adult men Multinodular goitre and solitary nodules sometimes present with acute painful enlargement due to haemorrhage into a nodule only 5–10% of thyroid nodules are malignant. A nodule presenting in childhood or adolescence, particularly if there is a past history of head and neck irradiation, or one presenting in an elderly patient should heighten suspicion of a primary thyroid malignancy

presence of cervical lymphadenopathy also increases the likelihood of malignancy secondary deposit from a renal, breast or lung carcinoma presents as a painful, rapidly growing, solitary thyroid nodule. broad differential diagnosis of anterior neck swellings, which includes lymphadenopathy, branchial cysts, dermoid cysts and thyroglossal duct cysts Serum T3, T4 and TSH should be measured in all patients with a goitre or solitary thyroid nodule doubt as to the aetiology of an anterior neck swellin....

Overview Nodules can be multiple or single, hot or cold Overview Nodules can be multiple or single, hot or cold. Most solitary nodules are cold, and most of those are benign. Virtually all hot or purely cystic nodules are benign.. 5% of patients who had neck radiation as a child (especially with > I 00 rads) get malignant nodules (mostly papillary carcinoma), and even more get nonmalignant ones (colloid adenoma) ,

Here are some helpful generalities: Autonomously functioning nodules ( "hot" nodules) are never malignant. So, a single hot nodule is not evaluated further. Histology from a hot thyroid nodule may be indistinguishable from a follicular thyroid malignancy, which could lead to high false positive rates and possibly unnecessary treatment with surgery or RAT. So, do not ever recommend biopsy for a hot nodule! Never, ever! • The majority of nodules are cold, and the majority of these are benign, but thyroid malignancies also present as cold nodules

Cold nodules in a patient with Graves' still are evaluated because they may be malignant. Multinodular goiters (MNG) can have both hot and cold nodules. (If a hot nodule is hot enough, it becomes a toxic MNG) Evaluate the cold nodules because cold nodules in MNG and solitary cold nodules have the same overall malignant risk. Do not routinely screen for thyroid nodules with U/S unless the patient has risk factors for malignancy; however, all palpable nodules (including MNGs) should be viewed with U/S as a general rule.

Workup of solitary nodules: Start with a good Hx and PE. Then, thyroid U/S (even if the nodule was found on CT or MRI) and a TSH. • Do an FNA. no matter the size or type of nodule or the level of TSH. Note that high levels of TSH correlate with increased likelihood that a nodule is malignanty. Large nodules (> 1 em) usually are biopsied based on size alone (unless the nodule is "hot").. Do a scintigraphy scan

a palpable nodule and is hyperthyroid, a RAIU and scintigraphy should always precede a thyroid ultrasound (U/S). When a patient presents with a palpable nodule and is hypothyroid or euthyroid, the next step in the workup is to go directly to U/S. Ultrasound (U/S) is used to determine the size and number of nodules, to determine whether a nodule is cystic or solid, to stratify a nodule's malignancy risk (low, medium, or high), to localize a nodule for fine needle aspiration, to follow up a nodule's size over time when malignancy is suspected, and to follow up a patient after thyroid cancer resection

Thyroid scintigraphy with 99mtechnetium should be performed in an individual with a low serum TSH and a nodular thyroid to confirm the presence of an autonomously functioning (‘hot’) nodule .. ‘Cold’ nodules on scintigraphy have a much higher likelihood of malignancy, but the majority are benign. Fine needle aspiration cytology is recommended are radiologically indeterminate. Fine needle aspiration of a thyroid nodule can be performed in the outpatient clinic, usually under ultrasound guidance. Aspiration may be therapeutic for a cyst.Fine needle aspiration cytology cannot differentiate between a follicular adenoma and a follicular carcinoma

Management. In parts of the world with borderline low iodine intake, there is evidence that levothyroxine therapy, in doses that suppress serum TSH, may reduce the size of some nodules.. Nodules that are suspicious for malignancy are treated by surgical excision, by either lobectomy or thyroidectomy. Nodules that are radiologically and/or cytologically indeterminate are surgically excised. Molecular techniques, improve the diagnostic accuracy of thyroid cytology and for indeterminate biopsy... 131I therapy may also cause some reduction in size of a multinodular goitre. Levothyroxine therapy may shrink the goitre of Hashimoto’s disease, particularly if serum TSH is elevated

References= Davidson +medstudy Thank You Thank you References= Davidson +medstudy