Thyroid nodule: Workup: 1st test [ABSITE, P.103]

1st: thyroid function tests

the absite review, p.103

Thyroid nodule: Treatment: For asymptomatic thyroid nodule with elevated thyroid function tests [ABSITE, P.103]

- If perform thyroid function test, and if elevated, give thyroxine; nodule should regress within 6 months

the absite review, p.103

Thyroid nodule: Prognosis: Expected course if you give patient with asymptomatic nodule and elevated TFTs, thyroxine [ABSITE, P.103]

- If perform thyroid function test, and if elevated, give thyroxine; nodule should regress within 6 months

the absite review, p.103

Thyroid nodule: Workup: 2nd test [ABSITE, P.103]

2nd test is fine-needle aspiration (FNA)

the absite review, p.103

Thyroid nodule: Workup: Next step if thyroid function test is not elevated [ABSITE, P.103]

- If thyroid funtion tests not elevated, proceed with FNA

the absite review, p.103

Thyroid nodule: Workup: FNA: How helpful is FNA? [ABSITE, P.103]

- Fine needle aspiration is determinant in 75-90%

the absite review. p.103

Thyroid nodule: Treatment: If FNA shows follicular cells [ABSITE, P.103]

- If FNA shows follicular cells --> thyroidectomy or lobectomy

the absite review, p.103

Thyroid nodule: Prognosis: Malignancy risk if FNA shows follicular cells [ABSITE, P.103]

- If FNA shows follicullar cells, 5-10% malignancy risk

the absite review, p.103

Thyroid nodule: Treatment: If FNA shows thyroid cancer [ABSITE, P.103]

- If FNA shows thyroid cancer --> thyroidectomy or lobectomy and appropriate treatment

the absite review, p.103

Thyroid nodule: Treatment: If FNA shows cyst fluid [ABSITE, P.103]

- If FNA shows cyst fluid --> drain fluid

- If it recurs, --> thyroidectomy or lobectomy

the absite review, p.103

Thyroid nodule: Treatment: Thyroid cyst recurs after cyst was initially drained [ABSITE, P.103]

- If it recurs, --> thyroidectomy or lobectomy

the absite review, p.103

Thyroid nodule: Treatment: If FNA shows colloid tissue [ABSITE, P.103]

- If FNA shows colloid tissue --> most likely colloid goiter

- low chance of malignancy (<1%)

- Tx: thyroxine; thyroidectomy or lobectomy if it enlarges

the absite review, p.103

Thyroid nodule: Pathology: Most likely condition if FNA shows colloid tissue [ABSITE, P.103]

- If FNA shows colloid tissue --> most likely colloid goiter

- low chance of malignancy (<1%)

- Tx: thyroxine; thyroidectomy or lobectomy if it enlarges

the absite review, p.103

Thyroid nodule: Prognosis: Likelihood of malignancy if FNA shows colloid tissue [ABSITE, P.103]

- If FNA shows colloid tissue --> most likely colloid goiter

- low chance of malignancy (<1%)

- Tx: thyroxine; thyroidectomy or lobectomy if it enlarges

the absite review, p.103

Thyroid nodule: Workup: 3rd test [ABSITE, P.103]

- Radionuclide study

- If FNA is indeterminant, get radionuclide study

the absit ereview, p.103

Thyroid nodule: Workup: Next step if FNA is indeterminant [ABSITE, P.103]

- If FNA is indeterminant in 10-25% --> get radionuclide study

the absite review, p.103

Thyroid nodule: Workup: FNA: % chance FNA will be indeterminant [ABSITE, P.103]

- FNA indeterminnat in 10-25%

- If indeterminant, get radionuclide study

the absite review, p.103

Thyroid nodule: Treatment: Treatment of hot nodule on radionuclide study [ABSITE, P.103]

Hot nodule

-  thyroxine for 6 months, if size does not decrease, perform lobectomy

the absite review, p.103

Thyroid nodule: Treatment: Treatment of hot nodule if it does not respond to thyroxine after 6 months [ABSITE, P.103]

- Hot nodule

- thyroxine for 6 months; if size does not decrease, perform lobectomy

the absite review, p.103

Thyroid nodule: Treatment: Cold nodule [ABSITE, P.103]

- Cold nodule --> thyroidectomy or lobectomy

the absite review, p.103

Thyroid nodule: Pathology: Cold nodule risk of malignancy [ABSITE, P.103]

Cold nodule

- more likely malignant than hot nodule

the absite revewi, p.103

Thyroid nodule: Pathology: Risk of malignancy [ABSITE, P.103]

- 85% of thyroid nodules are benign

the absite review, p.103

Thyroid nodules: History: Is there a male or female predominance? [ABSITE, P.103]

- Thyroid nodules have a female predominance

the absite review, p.103

Thyroid nodule: Workup: Ultrasound [Schwartz, p.1352]

- Ultrasound is an excellent noninvasive and portable imaging study of the thyroid gland with the added advantage of no radiation exposure.

- It is helpful in the evaluation of thyroid nodules, distinguishing solid from cystic ones, and providing information about size and multicentricity.

Ultrasound also can be used to assess for cervical lymphadenopathy (Fig 38-11) and to guide FNAB.

An experienced ultrasonographer is necessary for the best results.

the absite review, p.1352