Chapter 57: Thyroid Gland- Thyroid Nodule Flashcards
What percentage of people have a thyroid nodule?
≈5%
What is the differential diagnosis of a thyroid nodule?
- Multinodular goiter
- Adenoma
- Hyperfunctioning adenoma
- Cyst
- Thyroiditis
- Carcinoma/lymphoma
- Parathyroid carcinoma
Name three types of nonthyroidal neck masses
Inflammatory lesions
- abscess
- lymphadenitis
Congenital lesions
- thyroglossal duct midline
- branchial cleft cyst lateral
Malignant lesions:
- lymphoma
- metastases
- squamous cell carcinoma
What studies can be used to evaluate a thyroid nodule?
- U/S—solid or cystic nodule
- Fine-Needle Aspirate (FNA) → cytology
- 123I scintiscan—hot or cold nodule
What is the DIAGNOSTIC test of choice for thyroid nodule?
FNA
What is the percentage of false negative results on FNA for thyroid
nodule?
≈5%
What is meant by a “hot” versus a “cold” nodule?
Nodule uptake of IV 131I or 99mT
- Hot—Increased 123I uptake = functioning/hyperfunctioning nodule
- Cold—Decreased 123I uptake = nonfunctioning nodule
What are the indications for a 123I scintiscan?
- Nodule with multiple “nondiagnostic” FNAs with low TSH
- Nodule with thyrotoxicosis and low TSH
What is the role of thyroid suppression of a thyroid nodule?
Diagnostic and therapeutic; administration of thyroid hormone suppresses TSH secretion, and up to half of the benign thyroid nodules will disappear!
In evaluating a thyroid nodule, which of the following suggest
thyroid carcinoma:
History?
- Neck radiation
- Family history (thyroid cancer, MEN-II)
- Young age (especially children)
- Male > female
In evaluating a thyroid nodule, which of the following suggest
thyroid carcinoma:
Signs?
- Single nodule
- Cold nodule
- Increased calcitonin levels
- Lymphadenopathy
- Hard, immobile nodule
In evaluating a thyroid nodule, which of the following suggest
thyroid carcinoma:
Symptoms?
- Voice change (vocal cord paralysis)
- Dysphagia
- Discomfort (in neck)
- Rapid enlargement
What is the most common cause of thyroid enlargement?
Multinodular goiter
What are indications for surgery with multinodular goiter?
- Cosmetic deformity
- compressive symptoms
- cannot rule out cancer
What is Plummer’s disease?
Toxic multinodular goiter
