Thyroid Nodule
last authored: Sept 2009, David LaPierre
Introduction
Thyroid nodules are very common and usually benign, but thyroid cancer is a concern which must be ruled out.
The Case of...
A 33 year-old woman goes to her GP because of a slowly growing mass in her neck. Her physician performs a thyroid exam and detects a 2 cm solid nodule on the left lobe of her thyroid.
Q: what further history do you ask?
Differential Diagnosis
Two-thirds of fine needle aspirates show benign cells, 15% show malignancy, and 15% are indeterminate.
- colloid nodule
- papillary carcinoma
- medullary carcinoma
- psammoma bodies (seen with papillary cancer)
- amyloid deposits (seen with medullary cancer)
- undifferentiated cells (anaplastic cancer)
- Hurthle cells (adenoma or low grade cancer)
- Follicular cells (nondiagnostic; cancer is possible)
- lymphocytic infiltrate (lymphoma or lymphocytic thyroiditis)
History and Physical Exam
- history
- physical exam
History
family history
radiation exposure
hoarseness
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Thyroid function tests are nondiagnostic, though can be used to follow response to thyroid suppression therapy.
Diagnostic Imaging
Fine needle aspiration is the first step in diagnosing a thyroid nodule.
Ultrasound is used to follow cysts identified via FNA but not diagnose them.
Scans are rarely done today, due to low sensitivity and specificity.
Management
Pathophysiology
The Case of...
Additional Resources
Topic Development
created: DLP, Aug 09
authors: DLP, Aug 09
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