Thyroid Nodules Flashcards
If incidental thyroid nodule >1 cm found what to do next?
TSH
risk factors for malignant thyroid nodules?
exposure to ionizing radiation (esp in childhood)
family history of thyroid cancer
thyroid cancer syndrome (MEN2,
familial polyposis, Cowden syndrome)
Age<30 or age >60 yrs
iodine deficiency elevated TSH
nodule characteristics that are risk factors for malignant thyroid nodules?
rapid growth,
hard/fixed nodule associated with cervical LAD
obstructive symptoms (hoarseness, dysphagia)
ultrasound size >1 cm
and microcalifications, hypoechoic increased vascularity and infiltrative margins, length>width
what to ask about for ruling out history of thyroid cancer?
any ionizing radiation to head and neck as a kid (cancer tx or nuclear fall out)
family hx of thyroid cancer or MEN
has thyroid nodule been rapidly increasing in size and
is there cervical LAD
if a low TSH and thyroid nodule that means this is MORE/LESS likely cancerous
less likely as it’s hyperfunctioning
what should be done after someone is found to have suspicious features on U/S of thyroid nodule?
need a fine needle aspiration of nodules
what are suspicious features for cancer on U/S of a thyroid nodule
ultrasound size >1 cm
microcalifications,
hypoechoic increased vascularity
infiltrative margins (indistinct margins) ,
length>width larger nodules
if a high TSH and thyroid nodule is that MORE/LESS likely cancerous
more likely most cancerous thyroid nodules are non functioning
are smoking and alcohol risk factors for malignant thyroid nodules
no.
incidence of malignant thyroid nodules:
4-6% of cases
Algorithm for thyroid nodule evaluation
FNA indications for a thyroid nodule based on U/S findings.
if U/s and FNA show benign (isoechoic, hyperechoic, partially cystic, spongiform) thyroid nodules, what do you do next?
after evaluation and are found to be benign thyroid nodules, need to follow them with surveillance with 6-12 months repeat U/S of thyroid to see if anything has changed.
If they grow to >1.5-2cm they need biopsied.
Pure cystic are almost always benign and do not need FNA
when to get surgery for pt?
when FNA shows cytological features (definitive or suspicious) for malginancy or non diagnostic cytology on multiple FNAs or if pt has compression symptoms.
Evaluation of thyroid nodule if there’s a 2cm x 2cm and TSH is low and normal T3?
What to order next?
order a radioactive iodine scintigraphy to see if thyroid nodule is cold or indeterminant. if it’s “hot” then treat hyperthyroidism
