Thyroid nodules

Question 1

What is a Thyroid nodule?

Answer 1

Abnormal growth of thyroid cells that forms a lump in the thyroid gland.

Question 2

Describe the aetiology of Thyroid nodules

Answer 2

Majority BENIGN, but small proportion turn into thyroid cancer
Most thyroid nodules are adenomatous+ most are multiple
Usually non-functioning

Question 3

Describe the epidemiology of Thyroid nodules

Answer 3

40% of general pop. have a single/ multiple nodules
F > M
Very small % malignant

Question 4

How do patients with Thyroid nodules present?

Answer 4

Most ASYMPTOMATIC
Usually found on self/ clinical examination
A single isolated nodule is more likely to be malignant
Sometimes cause pain
Rarely compress the trachea or cause dysphagia

Question 5

How do you examine for thyroid nodules?

Answer 5

Ask pt to drink water (nodules moves on swallowing)

Check for regional lymphadenopathy (consider malignancy)

Question 6

What investigations are performed for Thyroid nodules?

Answer 6

TFTs
Ultrasound 
FNA
Radionuclide Isotope Scanning: checks iodine uptake  
CT/MRI: detect spread of thyroid cancer

Question 7

What do TFTs show in most cases of Thyroid nodules?

Answer 7

euthyroid (normal functioning thyroid)

Question 8

Why is ultrasound used in suspected Thyroid nodules?

Answer 8

To determine character of the thyroid nodules

Question 9

What does FNA allow for when investigating Thyroid nodules?

Answer 9

cytological analysis

Question 10

Describe a stereotypical presentation of a multi nodular goitre

Answer 10

Middle aged women
Dysphagia
Bumpy swelling
Usually euthyroid but some cases a nodule can become autonomous + into a thyroxine-secreting adenoma

Question 11

What are the 4 types of thyroid nodules/ swellings?

Answer 11

Solitary nodule (may become "hot"-hyper)
Multinodular goitre
Diffuse goitre (usually AI hyper/hypo)
Retrosternal goitre (may compress oesophagus)