Thyroid Nodule

Question 1

Which thyroid nodules should be evaluated for malignancy?

Answer 1

1. Solid Nodule > 10mm
2. Spongy Nodule > 20mm
3. Certain radiological features
4. FHx of thyroid cancer
5. Hx of head and neck irradiation
6. Rapid growth of nodule, hoarseness, associated lymphadenopathy

Question 2

What are some suspicious features on US when looking at a thyroid nodule?

Answer 2

1. Hypoechoic
2. Microcalfication
3. Increased vascularity
4. Infiltrative margins
5. Absent halo
6. Taller than wide

Question 3

What could a thyroid nodule be? Ddx?

Answer 3

1. Benign
2. Non-diagnostic
3. Follicular lesion or atypic of undetermined significance
4. Follicular neoplasm
5. Suspicious malignancy
6. Malignant

Question 4

What does a papillary nodule look like on cytology?

Answer 4

High cellularity

Pseudoinclusions

Question 5

How are malignant thyroid nodules managed?

Answer 5

1. Total thyroidectomy
   thyroid cancer > 1cm
2. Hemithyroidectomy
   for small, low risk, unifocal, no FHx or obvious cervical LN mets.

Question 6

What are the adjuvant treatments for thyroid cancer?

Answer 6

1. Radioactive iodine remnant ablation

2. Thyroid hormone suppression therapy

Question 7

What are the long term follow ups for patients with thyroid cancer based on risk stratification?

Answer 7

Clinical examination every 12 months

Thyroid/neck US at 1 year and then based on risk

Serum thyroglobulin + thyroglobulin Ab at 12 months

Question 8

What will the lab tests be like in a multi nodular goitre?

Answer 8

Thyroid levels will be normal

Question 9

What are the indications for surgery in a multi nodular goitre?

Answer 9

1. Evidence of malignancy
2. Increased size of dominant nodule
3. Symptomatic
4. Retrosternal extension

Question 10

What are the TSH levels in thyrotoxicosis?

Answer 10

1. Low TSH

2. High T3 and T 4

Question 11

What is the diagnosis of a single nodule with TFT indicating thyrotoxicosis?

Answer 11

1. Toxic nodule - nodule autonomously producing thyroid hormone
2. Grave’s disease with incidental nodule

Question 12

What other useful test can be done with a thyroid nodule and with TFT indicating thyrotoxicosis?

Answer 12

Thyroid scan

Question 13

What are the treatment options of a toxic nodule?

Answer 13

1. Radioactive iodine

Question 14

What needs to be done for follow-up of radioactive iodine therapy?

Answer 14

1. Look at TFT

2. If TSH still low it is normal because improvement in TSH often lags behind and will normalize later