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Evaluating Thyroid Nodules in 5 min
K Hyasat
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Common, up to 5% adults have palpable nodule
Incidental on carotid USS, neck CT or PET Nodules can be multiple/single, hot or cold: 5-10% malignant
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Utiger RD. N Engl J Med 2005;352:2376-2378.
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Risk factors for Malignant Nodules
Hx head & neck radiation FHx of thyroid cancer Age < 20 or >70 Male Growing nodules Firm or hard consistency Lymphadenopathy Fixed Symptoms of compression
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TSH Serum TSH TSH low = overt or subclinical hyperthyroidism ie possibility that the nodule is hyperfunctioning → thyroid scintigraphy TSH normal or elevated → FNA if suspicious
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USS
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Thyroid scintigraphy Determine the functional status of a nodule
Iodine or technetium-99m Performed in patients with a low serum TSH concentration Select nodules for FNA Nonfunctioning nodules appear cold → FNA Hyperfunctioning nodules appear hot
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FNA Indications Without risk factors for thyroid cancer, FNA for solid hypoechoic nodules >1 cm Solid nodules that are isoechoic or hyperechoic, ≥1.0 to 1.5 cm Mixed cystic-solid nodules without suspicious features on USS, if ≥2.0 cm Spongiform nodules >2.0 cm Purely cystic nodules DO NOT require biopsy FNA for all nodules >5 mm in high-risk patients
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Benign nodule
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Malignant nodule – Hypoechogenic & microcalcifications
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Hyperfunctioning nodule
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Multinodular Goitre
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