1. Evaluating Thyroid Nodules in 5 min
K Hyasat

2. Common, up to 5% adults have palpable nodule
Incidental on carotid USS, neck CT or PET
Nodules can be multiple/single, hot or cold:
5-10% malignant

4. Utiger RD. N Engl J Med 2005;352:2376-2378.

5. Risk factors for Malignant Nodules
Hx head & neck radiation
FHx of thyroid cancer
Age < 20 or >70
Male
Growing nodules
Firm or hard consistency
Lymphadenopathy
Fixed
Symptoms of compression

6. TSH
Serum TSH
TSH low = overt or subclinical hyperthyroidism ie possibility that the nodule is hyperfunctioning → thyroid scintigraphy
TSH normal or elevated → FNA if suspicious

7. USS

8. Thyroid scintigraphy Determine the functional status of a nodule
Iodine or technetium-99m
Performed in patients with a low serum TSH concentration
Select nodules for FNA
Nonfunctioning nodules appear cold → FNA
Hyperfunctioning nodules appear hot

9. FNA Indications
Without risk factors for thyroid cancer, FNA for solid hypoechoic nodules >1 cm
Solid nodules that are isoechoic or hyperechoic, ≥1.0 to 1.5 cm
Mixed cystic-solid nodules without suspicious features on USS, if ≥2.0 cm
Spongiform nodules >2.0 cm
Purely cystic nodules DO NOT require biopsy
FNA for all nodules >5 mm in high-risk patients

13. Benign nodule

14. Malignant nodule – Hypoechogenic & microcalcifications

15. Hyperfunctioning nodule

16. Multinodular Goitre