Thyroid Nodule Case Studies Palak Choksi MD Intended

Thyroid Nodule Case Studies Palak Choksi, MD

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

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)

NOT ALL NODULES ARE OBVIOUS

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

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

Family history Head or neck irradiation 2 first degree relatives with history of thyroid cancer Genetic syndromes (RET, FAP)

Ultrasound: The Gold Standard Anyone found to have, OR is suspected of having a nodule evaluate by ultrasound!

HIGH SUSPICION

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

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