THYROID NODULE

Question 1

Essentials of diagnosis of a Patient with a Thyroid Nodule

Answer 1

(a) Commonly found during careful thyroid examinations
(b) Thyroid ultrasound and thyroid function tests mandatory
(c) If warranted based on ultrasound characteristics (shape, calcifications, hyperechogenicity) a fine needle biopsy is necessary for diagnosis

Question 2

General Considerations of a Patient with a Thyroid Nodule

Answer 2

(a) Most small thyroid nodules are asymptomatic and discovered incidentally on physical or radiologic examination
(b) Although 90% of thyroid nodules are benign, the presence of a thyroid nodule warrants referral to endocrinology by an IDC.
(c) Causes of solitary thyroid nodule include
1) Benign adenoma
2) Colloid nodule
3) Cyst
4) Primary thyroid malignancy or (less frequently) metastatic neoplasm
(d) Higher risk of malignancy if
1) History of head-neck radiation in childhood
2) Family history of thyroid cancer
3) Personal history of another malignancy

Question 3

Clinical Findings of a Patient with a Thyroid Nodule

Answer 3

(a) Small thyroid nodules usually asymptomatic.
(b) Most of the time the only signs and symptoms is the nodule.
(c) Signs and symptoms depend on the cause of the nodule and may cause hypo or hyperthyroid signs/symptoms.
(d) Toxic multinodular goiter and hyperfunctioning nodules can cause
hyperthyroidism
1) Sweating
2) Weight loss
3) Anxiety
4) Loose stools
5) Heat intolerance
6) Tachycardia
7) Tremor
(e) Thyroid nodules or multinodular goiter can grow and cause cosmetic embarrassment, discomfort, hoarseness, or dysphagia
(f) Large retrosternal multinodular goiters can cause dyspnea due to tracheal compression

Question 4

Clinical Findings of a Patient with a Thyroid Nodule Malignancy is suggested by

Answer 4

1) Hoarseness or vocal cord paralysis
2) Nodules in men or young women
3) Nodule that is solitary, firm, large, or adherent to trachea or strap muscles
4) Vocal cord paralysis
5) Enlarged lymph node(s)
6) Distant metastatic lesions