thyroid nodules

Question 1

what is a thyroid nodule ?

Answer 1

a discrete lesion within the thyroid gland that is palpable and/or ultrasonographically distinct from the surrounding parenchyma

Question 2

are thyroid nodules cancers?

Answer 2

most of them are not, but can be pre cancerous

Question 3

what are some benign nodular thyroid diseases?

Answer 3

multi nodular goitre, hashimotos thyroiditis, follicular adenomas, subacute thyroiditis

Question 4

what are some malignant nodular thyrooid disease

Answer 4

papillary carcinoma, follicular carcinoma, medullary carcinome and anaplastic carcinoma

Question 5

what are the symptoms of nodular thyroid disease ?

Answer 5

usually discovered accidentally but any pressure symptoms could be present such as dysphagia, dyspnea , dysphonia, hoarseness and a choking sensation

Question 6

what other main symptoms could be present ?

Answer 6

sudden pain which may be due to haemorrhage or a cyst
**rapid enlargement **- could be anaplastic carcinoma or a primary lymphoma
pemberton’s sign

Question 7

what is pemberton’s sign ?

Answer 7

growth of nodular goitre in the anterior mediastinum , so when the patient raises their arm above their head their face becomes plethoric due to jugular vein distention

Question 8

what investigations would be performed with patients with a palpable nodule ?

Answer 8

thyroid ultrasound , it is not a screening test in addition to thyroid function tests and fine needle aspirate and radionuclide scans

Question 9

what are some suspicious feature that could be present in a thyroid nodule

Answer 9

increased vascularity, irregular margins, micro calcifications, extra capsular growth

Question 10

laboratory testing ?

Answer 10

test for TSH first if that is normal no more testing is required, if TSH is high teste T3 and T4 and anti thyroid antibodies to evaluate for hypothyroidism
if TSH is low test T3/4 to evaluate for hyperthyroidism

Question 11

results in Radionuclide scanning in noodulles?

Answer 11

if its a hot nodule its almost never malignant,
if its a** cold** nodule theres a 5-8% chance of malignancy

Question 12

when do we order a radionuclide scan ?

Answer 12

• for a thyroid nodule or multi nodular goitre
• If TSH is below the lower limit of the normal range
• In search of ectopic tissue

Question 13

what are the treatment option for thyroid nodules ?

Answer 13

surgery (total or subtotal thyroidectomy)
radioiodine ablation
follow up

Question 14

what are the indications of surgery ?

Answer 14

presence of malignant lesions 
toxic thyroid nodules
compressive symptoms
retrosternal extension
cosmetic indications

Question 15

what are the complications of surgery?

Answer 15

external laryngeal nerve injury (volume loss)
recurrent laryngeal nerve injury (horsness of voice)
hypoparathyroidism
bleeding

Question 16

what are the contraindications of using radioiodine ablation ?

Answer 16

**Radioiodine therapy is used iin hyperthyroidism **
in pregnancy or lactating or if the patient suffers from eye disease as it may worsen the ophthalmology

Question 17

radioiodine therapy first line therapy?

Answer 17

not the first line of treatment if there are compressive symptoms or large nodules present
however when used repeat in 3-6 months if not successful

Question 18

what are the indications for performing thyroid ultrasound in thyroid patients ?

Answer 18

only in patients with palpable thyroid lesion on examination and with patients who have a positive family history of thyroid cancer