Thyroid Nodules and Differentiated Thyroid Cancer Thyroid Nodules
Key Points
Key Points
The clinical importance of thyroid nodules rests with the need to exclude thyroid cancer, which occurs in 7–15% depending on age, sex, radiation exposure history, family history, and other factors.
Thyroid sonography with survey of the cervical lymph nodes (LN) should be performed in all patients with known or suspected thyroid nodules (recommendation 6)
Thyroid nodules should be assessed for risk of malignancy by the ATA sonographic risk pattern (recommendation 8), not simply by size.
Not every thyroid nodule > 1 cm needs fine- needle aspiration (FNA), and most nodule < 1 cm do not need FNA (recommendation 8)
Thyroid nodule FNA cytology should be reported using diagnostic groups outlined in the Bethesda System for Reporting Thyroid Cytopathology (recommendation 9)
Molecular testing can be useful in patients with indeterminate FNA cytology, and is primarily considered for patients with AUS/FLUS and FN/SFN cytology (recommendations 13-17)
Monitoring approaches to patients with benign FNA cytology and those who do not undergo FNA, should be based on the sonographic risk pattern (recommendations 23 and 24)
Routine TSH suppression is not recommended for patients with benign thyroid nodules (recommendation 25)
Pregnant women with FNA cytology that is malignant (PTC) can undergo surgery in the second trimester, but surgery can be deferred until after pregnancy if there are no clinically concerning features or substantial growth (recommendation 31)
Diagnosis
Diagnosi...
...Screening people with familial follicular cel...
...m TSH should be measured during the initial...
...TSH123 is subnormal, a radionuclide (preferab...
...erum TSH is normal or elevated, a radionucl...
...asurement of serum Tg for initial evaluati...
...annot recommend either for or again...
...DG-PET uptake within a sonographically...
...B) Diffuse 18FDG-PET uptake, in conjunction with...
.... Thyroid sonography with survey of...
...e procedure of choice in the evaluation of thy...
...in greatest dimension with high suspicion...
...cm in greatest dimension with intermediat...
...>1.5 cm in greatest dimension with low suspicion s...
...dule diagnostic FNA may be considered for (Figure...
...dule diagnostic FNA is not required for (Fig...
...Nodules that are purely cystic. (SR, M)6...
...d nodule FNA cytology should be reported us...
...or a nodule with an initial nondiagnost...
...Repeatedly nondiagnostic nodules without...
10. C) Surgery should be considered...
...the nodule is benign on cytology, further immedi...
.... If a cytology result is diagnostic for prim...
13. If molecular testing is being considered, p...
...nded for clinical use, molecular testing...
...r nodules with AUS/FLUS cytology, after consider...
...t FNA cytology and/or molecular testing are not...
...A) Diagnostic surgical excision is the...
...olecular testing is either not performed or inc...
...tology is reported as suspicious for papillary...
...onsideration of clinical and sonographic features...
...aging is not routinely recommended for the evalua...
...uation and Management of Patients With Thyroid...
...ATA Nodule Sonographic Patterns and Risk of...
...Lymph Node Compartments Separated into Levels a...
.... Sonographic Patterns, Estimated Ris...
Treatment
...eatment
...surgery is considered for patients...
...Because of increased risk for malignancy, total...
...tients with indeterminate nodules wh...
...A) Patients with multiple thyroid nodules...
...ltiple nodules >1 cm are present, tho...
...If none of the nodules has a high or moderate sus...
...low or low-normal serum TSH123 concentration...
...ith high suspicion US pattern: repeat USA) Nodules...
...les with low to intermediate suspi...
...les with very low suspicion US pattern (includ...
...with high suspicion US pattern: repeat US...
...dules with sonographic features of low...
...with very low suspicion US pattern (inclu...
...) Nodules
E) Nodule...
...suppression therapy for benign thyroid nodules i...
...patients with benign, solid or mostly s...
...A) Surgery may be considered for growi...
...nts with growing nodules that are be...
.... Recurrent cystic thyroid nodules with benign c...
...e are no data to guide recommendations on the...
...) FNA of clinically relevant thyroid nodules shoul...
...B) For women with suppressed serum TSH levels tha...
...discovered by cytology in early pregnancy sh...
...egnant women with FNA that is suspici...