Thyroid nodules

Question 1

Initial step after identification of thyroid nodule on clinical exam or incidentally on imaging

Answer 1

measure TSH

Question 2

Next step if nodule present + low TSH

Answer 2

thyroid scintography

Question 3

Nodule on scintography + low TSH + high T3, T4

Answer 3

hot nodule, hyperthyroidism requiring treatment

Question 4

Next step if nodule present + normal TSH

Answer 4

Thyroid ultrasound

Question 5

Next step if nodule present + High TSH

Answer 5

thyroid ultrasound

Question 6

Thyroid nodule on ultrasound that has no indication for fine needle aspiration biopsy

Answer 6

if cystic OR size <1cm (without symptoms, without pathologic lymphadenopathy, without extrathyroidal extension, without childhood radiation, without history of familial thyroid cancer)

Question 7

FNA indicated when…

Answer 7

spongiform (mixed cystic and solid) nodule >2cm, isoechoic solid nodule >1.5cm, hyperechoic solid nodule >1.5cm, or hypoechoic solid nodule >1cm

Question 8

If FNA is negative, when should ultrasound be repeated if it is a high suspicion nodule?

Answer 8

in 6-12 months if it is a high suspicion nodule

Question 9

What makes a thyroid nodule high suspicion?

Answer 9

micfocalcifications, extrathyroidal extension, pathologic lymphadenopathy, or irregular margins

Question 10

Do you need to repeat FNA if two prior FNAs are negative?

Answer 10

no

Question 11

If FNA is negative, when should ultrasound be repeated if it is an intermediate suspicion nodule?

Answer 11

in 12-24 months if it is an intermediate suspicion nodule

Question 12

If FNA is negative, when should ultrasound be repeated if it is a low suspicion nodule?

Answer 12

In 24 months if it is a low suspicion nodule