THYROID NODULES Flashcards
what are thyroid nodules?
disordered growth of thyroid cells that form a lump or mass
can be a discrete nodule or a multinodular goiter
extremely common
are thyroid nodules always bad?
they can be palpated by the patient or PA or discovered incidentally
what are 90% of thyroid nodules?
benign adenomas, colloid nodules or cysts
what are the other 10% of thyroid nodules?
primary thyroid malignancy
metastatic malignancy
are nodules more common in males or females?
females
what are the risks for malignant nodules?
- males
- young age (<30 y/o)
- history of head-neck radiation
- FMHx thyroid cancer
- personal hx of another malignancy
- large, firm, solid solitary nodule or “cold nodule”
- associated cervical LAD
what is the clinical presentation of of thyroid nodules?
- asymptomatic
- symptoms:
> nodules or multinodular goiter thats visible
> ant. neck discomfort
> hoarseness
> dysphagia
> ipsilateral recurrent laryngeal nerve palsy
> hypothyroidism/hyperthyroidism - depends if fxning or not- fxning
on what different imaging methods can thyroid nodules be found?
- carotid ultrasound
- neck or chest CT
- PET
-no sx or observable lesion by exam -> thyroid cancer needs to be ruled out
what measurement of nodule requires further testing?
> or equal to 1
< 1cm in patients at high risk for thyroid cancer
what should all nodules be initially evaluated with?
thyroid ultrasound
in nodules > or greater than 1 cm and/or high-risk patient what labs should be drawn and what might they show?
- TSH and free T4
- may be low, normal, or high
- majority of patients are EUTHROID
why is thyroid US useful?
determines nodule size and characteristics (including adjacent structures)
what are benign features of thyroid nodules seen on US?
purely cystic, without solid components
what are high-risk features of thyroid nodules seen on US?
solid, hypoechoic- indicates solid mass of dense tissue , microcalcifications, irregular margins, extrathyroidal extension
when should a radionuclide thyroid scan be performed and what is the goal?
- performed when TSH is low
- goal is to examine if nodule is fucntioning or non-functioning
what is a nonfunctioning nodule referred to as and what is a hyperfunctioning nodule referred to as?
nonfunctioning: cold
hyperfunctioning: hot
what does a “cold” nodule mean?
iodine uptake less than surrounding tissue
must do FNA Biopsy
(everything got uptake except the nodule)
what does a “hot” nodule mean?
iodine uptake more than surrounding tissue
likely benign
repeat labs at 6 months
(only uptake in the nodule… will see black circle)
what is the best diagnostic method for assessing malignancy?
FNA Biopsy
what are indications for a FNA B?
- > or equal to 1 cm nodule AND:
- elevated/normal TSH + suspicious ultrasound findings
OR- low TSH + suspicious ultrasound findings +cold or indeterminate nodule (s)
- large nodule > or equal to 1.5 cm
- thyroid nodule of any size w/ risk factors:
- young age
- FMHx of thyroid cancer
- hx radiation
what is the treatment of a benign lesion?
- repeat ultrasound every 6 months initially
- in a stable lesion: repeat ultrasound yearly
- repeat FNA biopsy if growth occurs
- >2 mm of growth per year- higher likelihood of malignancy - can do suppression therapy with levothyroxine!!!!
- nodules <2 cm and/or increased TSH
- starting dose of 50 mcg PO daily
what is the tx for a cancerous lesion?
total thyroidectomy
what is a goiter?
chronic enlargement of the thyroid gland d/t non-neoplastic growth
can be overall enlargement or irregular cell growth that forms one or more nodules
what are the types of goiter?
- toxic- associated wtih hyperthyroidism
- nontoxic- associated with euthroidism
- hypothyroid- commonly seen in hashimotos thyroiditis
what is “other tx” for benign lesions? (later line)
OTHER TX:
1. radiofrequency ablation for lesions > or equal to 3 cm
2. radioiodine therapy for hyperthyroid patients with toxic thyroid adenomas or multinodular goiter
