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Thyroid NodulesEdit

Key points:

  • 5-10% of Thyroid Nodules will be cancerous
  • 5% of the population has a palpable thyroid nodule

HistoryEdit

History should include rapid growth, any neck radiation treatments, Family histories of cancer syndromes

  • Cowden's
  • FAP
  • Carney Complex
  • Werner Syndrome
  • MEN 2

Physical ExamEdit

Concerning exam findings

  • Nodule is fixed in position
  • Vocal cord paralysis
  • Lymphadenopathy

WorkupEdit

Starts with thyroid US and TSH
Suppressed TSH is usually good b/c hot nodules are usually not cancerous
The higher the TSH the more worrisome the nodule is (cancer risk rises with rising TSH)

UltrasoundEdit

The report will mention the size, if there is vascularity, cystic or non-cystic, location in the thyroid, lymphadenopathy, microcalcifications, irregular margins

Who needs a biopsy vs surveillanceEdit

FNA CriteriaEdit

FNA is the most accurate and cost-effective method for evaluating nodules Indications to get a diagnostic FNA:

  • Nodules that are > 1 cm (hyperechoic, irregular margins, microcalcifications, taller than wide, evidence of extrathyroidal extension
  • Nodules > 1.5 cm (iso or hyperechoic w/o any features
  • Nodules > 2 cm (cystic or spongiform)
  • Pure cysts (no need to biopsy)
  • Less than 1 cm - patient preference/risk factor based
  • Adjacent lymphnodes should be biopsied if - cystic, loss of hilum, calcification, peripheral vascularity

SurveillanceEdit

No evidence based guidelines on strategies
Recommendations from ATA suggest:
- High suspicion: repeat US in 6-12 months
- Low to intermediate: repeat US in 12-24 months
- Very low or pure cystic: Unknown utility of repeat US, if > 1 cm repeat after 2 years, if < 1 cm no need to repeat

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