1. Thyroid Nodule Case Studies
Palak Choksi, MD

2. Intended Learning Objectives
Discuss the various tools and diagnostic tests available for assessment of thyroid nodules
Review the current national guidelines for patients with thyroid nodules

3. Thyroid nodule
A discrete lesion that is either palpable and/or ultrsonographically distinct from the surrounding thyroid parenchyma
ATA Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer (2006 & 2009 Task Force)

5. NOT ALL NODULES ARE OBVIOUS

6. Symptoms Usually asymptomatic
Occasionally painful, rapid growing (cyst)
Difficulty swallowing
Hoarseness or change in voice
Shortness of breath while supine
+ pemberton’s signs
Hyper/hypothyroidism

7. Describe the physical examination
Visual inspection
Palpation of the thyroid, cervical and supraclavicular lymph nodes
Is the lesion fixed, mobile, soft, firm, hard or non tender?
Reflexes, heart rate, BP, weight changes

8. Family history Head or neck irradiation
2 first degree relatives with history of thyroid cancer
Genetic syndromes (RET, FAP)
HL, NHL, ALL< AML, brain tumors
Median dose to the thyroid: 2500 Gy
Median time to diagnosis of thyroid cancer: 15 years
Overall 25-39% rate of cancer detection

10. Ultrasound: The Gold Standard
Anyone found to have,
OR is suspected of having a nodule  evaluate by ultrasound!
Not invasive
inexpensive
 Dimension of gland and nodules
Is used to monitor size and growth
Helps determine IF a biopsy is necessary
Unique characteristics of nodules

11. HIGH SUSPICION

13. FNA
False-negative rate of up to 5%, maybe higher with nodules over 4 cm
Size is not a predictor for malignancy

14. FNA results Nondiagnostic Benign
Atypia of Undetermined Significance (AUS)
Suspicious for a Follicular Neoplasm/Follicular Neoplasm
Suspicious for Malignancy
Malignant
Bethesda System for Reporting Thyroid Cytopathology