Thyroid Nodule Biopsy - Is it cancer or just a benign nodule?
Most thyroid nodules are benign hyperplastic lesions, but % of a clear relationship between radiation exposure and thyroid cancer. Thyroid cancers typically present as a dominant solitary nodule that can be felt by the patient or even seen as a lump in the neck by his/her. Background: Clinically detectable thyroid nodules occur in up to 4% of the population in the United States. No significant relationship exists between the author and the com- resected from irradiated glands, the finding of one or.
Is the mass ever painful or has it enlarged rapidly recently? This may suggest bleeding into a cyst. Have you noticed a loss of voice or hoarseness?
This could suggest tracheal compression from a multinodular goiter, or in absence of a goiter could be concerning for a malignancy. Do you have a family history of cancer, specifically papillary thyroid cancer, medullary thryoid cancer, or MEN 2?
Family history or MEN 2 increases the risk of thyroid cancer. Do you have a history of neck irradiation? Neck irradiation increases the risk of thyroid cancer. Physical Examination maneuvers that are likely to be useful in diagnosing the cause of this problem.
Examination should include inspection, auscultation, and palpation of the thyroid gland. Specifics including size of any palpated nodules and mobility should be noted. Nodules that are hard, fixed to adjacent structures, and with regional lymphadenopathy are associated with a higher risk for malignancy.
Lymphadenopathy should be evaluated as well, including size, texture and mobility of any enlarged nodes. Laboratory, radiographic and other tests that are likely to be useful in diagnosing the cause of this problem. In patients who are asymptomatic diagnostic work up can be started in the outpatient setting after the patient has been discharged.
For symptomatic individuals, or in specific patients who desire initiation of the work up in the hospital, the following approach can be used see Figure 1 Figure 1. Flowchart for work up of thyroid nodule. Initial laboratory testing for patients with thyroid nodules should include TSH, thyroid peroxidase antibodies, and a free thyroxine or FT4 to assess thyroid function. In patients with a history of MEN2, a serum calcitonin level should be measured.
All patients with a palpable thyroid nodule, evidence of a goiter, or incidental finding on computed tomography CT or magnetic resonance imaging MRI should also undergo ultrasound.
Management of the Solitary Thyroid Nodule
Ultrasound can help identify the number of nodules, their size and location, and any evidence of worrisome sonographic signs. Thyroid gland fine needle aspiration FNA is the diagnostic test of choice to evaluate if a nodule has malignant cells. FNA can be performed with palpation or with ultrasound guided FNA and aspirate is sent for cytologic diagnosis.
If there are symptoms, evidence of thyroid dysfunction, worrisome ultrasound characteristics, or questions as to how frequently to follow up, patients should be referred to an endocrinologist. If the TSH is normal, no further lab testing is necessary. Proceed with ultrasound assessment.
If the TSH is high, the patient should get a free T4 and thyroid peroxidase antibodies checked to evaluate for hypothyroidism. High TPOAb are suggestive of an autoimmune thyroiditis as cause of the nodular thyroid. Proceed with ultrasound assessment given Hashimoto's thyroiditis is associated with lymphoma. If the TSH is low, the patient should get a free T4 and a free triiodothyronine to evaluate for hyperthyroidism. Thyroid scintigraphy can also be checked to assess for "hot nodules".
Thyroid nodules and thyroid cancer - Cancer Therapy Advisor
If the nodule is found to be hyperfunctioning, the risk of cancer is very low and patient likely does not need FNA. Sonographic features that predict malignancy include microcalcifications, irregular nodule margins, and chaotic intranodal vasculature. Evidence of any of these with a hypoechoic nodule suggests a malignancy. Cytologic analysis may yield benign results colloid nodule, macrofollicular adenoma, benign cyst, lymphocytic thyroiditis, or granulomatous thyroiditis.
Cytology may return with a positive result suggesting papillary carcinoma, follicular carcinoma, anaplastic carcinoma, medullary carcinoma, primary thyroid lymphoma, sarcoma, teratoma or other metastases. Malignant, suspicious, or persistently nondiagnostic results require surgical treatment. From a cohort of radiation-exposed people, we studied the that underwent thyroid surgery.
We studied the association between the size, number, distribution, and rank order of thyroid nodules and the chance of malignancy. There were malignant nodules in patients and benign ones in patients.
There was no change in the risk that a nodule was malignant with increasing size odds ratio 0. A solitary nodule had a similar likelihood of being malignant as a nodule that was one of several In radiation-exposed patients, the following conclusions were made: Childhood radiation exposure increases the chance that a person will develop both benign and malignant thyroid nodules 1 — 3.
Recently several endocrine organizations have released guidelines for evaluating and managing thyroid nodules 4 — 7.Thyroid Nodule Suspicious For Cancer - What Should I Do?
Additionally, they recommend total thyroidectomy when surgery is indicated in a radiation-exposed patient 5 — 7. We have been studying a cohort of radiation-exposed patients treated for benign conditions in the head and neck area predominantly in the s and s; patients subsequently had surgery for nodular thyroid disease and form the basis of the current study. The goal was to use the surgical findings to evaluate the recently promulgated recommendations by determining how the size of a thyroid nodule, the number of nodules, and the distribution of nodules influence the risk of malignancy in radiation-exposed patients.
Patients and Methods Radiation-exposed cohort We performed a retrospective analysis of data obtained in a cohort study of patients who were younger than 16 yr of age when they received external radiation treatments for various benign conditions of the head and neck area from to at Michael Reese Hospital in Chicago.
The Thyroid Follow-up Program began in when an effort was made to contact all irradiated patients, inform them about the radiation exposure, and invite them to participate in the study 89. The study was approved by the Michael Reese Hospital and University of Illinois at Chicago institutional review boards. During the study patients were invited to the study center at which they underwent a clinical evaluation, which included a physical examination of the head and neck area and thyroid imaging.
The imaging was initially thyroid scanning using Tc-pertechnetate with a pinhole collimator and then, afterthyroid ultrasound. When abnormalities were detected, patients were referred to their physicians for further management.
Malignancy in solitary thyroid nodule: A clinicoradiopathological evaluation
Patients also received questionnaires periodically. If a patient was diagnosed with a thyroid-related medical condition or underwent a procedure, the medical records, pathology reports, and pathology specimens were reviewed. A total of patients underwent thyroid surgery between and due to the presence of suspicious thyroid lesions. Most of the surgeries, The indications for surgery at that time were either the presence of a palpable nodule or an abnormal thyroid scan.
We were unable to obtain any pathology records for 21 patients and another 19 had no thyroid neoplasms found, leaving patients with at least one thyroid nodule that were included in the current study.
The extent of surgery, number of nodules per patient and their size, location, and histologic type benign or malignant were recorded. Thyroid nodule characteristics The size largest dimension in millimeters and the location right lobe, left lobe, or isthmus were recorded for each nodule according to the description in the pathology reports.
As a result of the pathology review, some early cases were reclassified from papillary adenomas to papillary cancers. Later, after most of the cases had been reviewed, with the recognition that there is a follicular variant of thyroid cancer, the histological classification of differentiated thyroid cancer changed Because the slides had been returned to the original institutions, cancers were reclassified based on the medical records.