thyroid nodule Flashcards
etiology of neck mass? mention thyroid and non thyroid related and mention locations of congenital masses
non thyroid: lipoma, thyroglossal duct cyst, brachial cleft cyst, lymphadenopathy, cystic hygroma
thyroid:
benign -> thyroid cyst, toxic adenoma (hot nodule), multinodular goiter, thyroid adenoma (papillary/ follicular/ hurthle cell)
malignant -> thyroid cancer, thyroid lymphoma
thyroglossal duct cyst: painless midline mass moves with swallowing and tongue protrusion
brachial cleft cyst: painless mass lateral to midline not move with swallowing
cystic hygroma: painless mass in posterior triangle with positive transillumination test (it’s filled with fluid)
approach to thyroid nodules?
history and physical exam
imp points to cover in history: hypo/hyperthyroidism symptoms, obstructive symptoms, risks of malignancy (rate of growth, hoarseness, painless, radiation exposure, family hx of thyroid cancer)
physical exam for thyroid and regional lymph nodes, pemberton sign (bilateral arm elevation will cause facial flushing due to venous obstruction)
TFT (hot/cold nodule)
thyroid ultrasound and based off findings decide on FNA
suspicious findings on ultrasound that may indicate malignancy?
solid, hypoechoic, calcifications, taller than wide, size >1.5cm, irregular borders
bethesda system for reporting thyroid cytopathology.
what to do?
1. nondiagnostic or unsatisfactory
2. benign (follicular cells)
3. atypia of undetermined significance
4. follicular neoplasm or suspicion for follicular neoplasm
5. malignant
- repeat FNA
- clinical follow up (benign lesion)
- repeat FNA
- surgical removal
- surgical removal
findings in TFT and treatment for toxic adenoma, multinodular goiter, thyroid cyst
tx for thyroglossal duct cyst, cystic hygroma, brachial cleft cyst
toxic adenoma and multinodular goiter: low TSH and high T4, give BB for symptomatic relief, antithyroid drugs to reach euthyroid state, then surgery or radioactive iodine ablation
thyroid cyst: normal TFT, clinical follow up unless symptomatic or patient preference for surgery
thyroglossal cyst: sistrunk procedure
cystic hygroma and brachial cleft cyst: surgical removal
