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Thyroid Nodule Case Studies

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1 Thyroid Nodule Case Studies
Palak Choksi, MD

2 Intended Learning Objectives
Discuss the various tools and diagnostic tests available for assessment of thyroid nodules Review the current national guidelines for patients with thyroid nodules

3 Thyroid nodule A discrete lesion that is either palpable and/or ultrsonographically distinct from the surrounding thyroid parenchyma ATA Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer (2006 & 2009 Task Force)

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5 NOT ALL NODULES ARE OBVIOUS

6 Symptoms Usually asymptomatic
Occasionally painful, rapid growing (cyst) Difficulty swallowing Hoarseness or change in voice Shortness of breath while supine + pemberton’s signs Hyper/hypothyroidism

7 Describe the physical examination
Visual inspection Palpation of the thyroid, cervical and supraclavicular lymph nodes Is the lesion fixed, mobile, soft, firm, hard or non tender? Reflexes, heart rate, BP, weight changes

8 Family history Head or neck irradiation
2 first degree relatives with history of thyroid cancer Genetic syndromes (RET, FAP) HL, NHL, ALL< AML, brain tumors Median dose to the thyroid: 2500 Gy Median time to diagnosis of thyroid cancer: 15 years Overall 25-39% rate of cancer detection

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10 Ultrasound: The Gold Standard
Anyone found to have, OR is suspected of having a nodule  evaluate by ultrasound! Not invasive inexpensive  Dimension of gland and nodules Is used to monitor size and growth Helps determine IF a biopsy is necessary Unique characteristics of nodules

11 HIGH SUSPICION

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13 FNA False-negative rate of up to 5%, maybe higher with nodules over 4 cm Size is not a predictor for malignancy

14 FNA results Nondiagnostic Benign
Atypia of Undetermined Significance (AUS) Suspicious for a Follicular Neoplasm/Follicular Neoplasm Suspicious for Malignancy Malignant Bethesda System for Reporting Thyroid Cytopathology

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