Thyroid Nodule

• • Very common and most are not cancer

  • Central diagnostic question is whether the lesion is benign or malignant

Epidemiology

• • Present in about 5% of the population

  • 5% of nodules represent thyroid cancer

  • 2-fold more common in females, although malignant nodules slightly more common in males

  • Risk of malignancy greater in persons older than 60 or in children younger than 15

Symptoms and Signs

• • Often asymptomatic, and discovered as a nodule on routine physical exam or exam for another head/neck pathology

  • Occasional pain

  • Hoarseness

Laboratory Findings

• • Serum thyroid-stimulating level (TSH) level (low in solitary toxic nodule, normal or elevated in nonfunctioning nodules)

  • Fine-needle aspiration biopsy can have the following results:

  • -Malignant

    -Benign

    -Indeterminate

    -Inadequate

Imaging Findings

• • US

  • -Can distinguish size of nodules and assess for presence of nonpalpable nodules

    -Also can distinguish solid from cystic nodules

  • Thyroid scintigraphy: Not routinely indicated; sole remaining indication is in patients with hyperthyroidism and thyroid nodule.

Rule Out

• • Thyroid cancer

• • Complete history and physical exam

  • -Focus on duration of swelling, recent growth, local symptoms (dysphagia, pain, voice changes), and systemic symptoms (hyperthyroidism, hypothyroidism); the patient's age, sex, place of birth, family history, and history of head/neck irradiation are most important

  • Thyroid function tests

  • Cervical ultrasound to assess thyroid and regional lymph nodes

  • Fine-needle aspiration biopsy; ultrasound-guided has a higher diagnostic rate

  • Observation, medical therapy, or surgery

  • Thyroid scintigraphy only if patient hyperthyroid (rare)

Surgery

Indications

• • Obstruction of the aerodigestive tract

  • FNA biopsy with malignant or indeterminate result

  • 3 successive inadequate biopsies

  • Recurrence of cyst after 2 aspirations

Medical

• • TSH suppression with l-thyroxine if patient hypothyroid; may arrest nodule growth

References