Exxcellence pearls: thyroid nodule

Question 1

What percentage of US women will have palpable thyroid nodules?

Answer 1

5%

Question 2

What thyroid nodules are significant enough to warrant a work up?

Answer 2

Nodules over 1 cm, family history of thyroid cancer, fixation, lymphadenopathy, vocal cord involvement.

Question 3

What historical features should be gathered in the setting of a thyroid nodule?

Answer 3

Speed of growth
History of head or neck radiation
Family history of first degree relative with thyroid cancer

Question 3

How often are follow-up ultrasounds recommended?

What would be a worrisome increase in size?

Answer 3

Every 6-18 months

15-20%

Question 4

What laboratory testing should be done to evaluate a thyroid nodule?

How should the results be managed?

Answer 4

TSH alone.

If this is a low, a radionucleotide thyroid scan can help determine if excess thyroid hormone is produced (a hot nodule). This is not concerning for cancer but hyperthyroidism needs to be treated.

If TSH is normal or elevated, then thyroid ultrasound is indicated with possible fine needle aspiration.

Question 6

Should thyroid suppression be given to women with benign thyroid nodules? Why or why not?

Answer 6

No. It does not shrink the nodules and may lead to osteoporosis and/or heart disease.