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
...agnosis
1. Screening people with familial follicul...
...TSH should be measured during the initia...
...If the serum TSH123 is subnormal, a r...
...serum TSH is normal or elevated, a radio...
...outine measurement of serum Tg for...
...el cannot recommend either for or against routin...
5. A) Focal 18FDG-PET uptake within a...
...use 18FDG-PET uptake, in conjunction...
...sonography with survey of the cervi...
...NA is the procedure of choice in the ev...
...) Nodules >1cm in greatest dimension with h...
...es >1 cm in greatest dimension with interme...
...5 cm in greatest dimension with low...
...odule diagnostic FNA may be considered for...
...odule diagnostic FNA is not required for (...
...at are purely cystic. (SR, M)623...
...ule FNA cytology should be reported us...
...nodule with an initial nondiagnostic cytology...
...atedly nondiagnostic nodules without a high suspi...
...) Surgery should be considered for histo...
...e nodule is benign on cytology, further immedi...
...f a cytology result is diagnostic...
...olecular testing is being consider...
...intended for clinical use, molecular...
...nodules with AUS/FLUS cytology, after cons...
15. B) If repeat FNA cytology and/or...
...6. A) Diagnostic surgical excision is the lon...
...B) If molecular testing is either...
...he cytology is reported as suspicio...
...fter consideration of clinical and sono...
...18FDG-PET imaging is not routinely recommended fo...
...ure 1. Evaluation and Management of Patient...
...dule Sonographic Patterns and Risk of Mal...
...igure 3. Lymph Node Compartments Separated i...
...graphic Patterns, Estimated Risk of Maligna...
Treatment
Treatme...
...When surgery is considered for patients with a...
...f increased risk for malignancy, tota...
.... B) Patients with indeterminate nodules wh...
...ts with multiple thyroid nodules >1 cm should...
...When multiple nodules >1 cm are present, those wi...
21. C) If none of the nodules has a hig...
...-normal serum TSH123 concentration in patients...
A) Nodules with high suspicion US pattern:...
...les with low to intermediate suspic...
...h very low suspicion US pattern (including s...
A) Nodules with high suspicion US pat...
...les with sonographic features of low...
...dules >1 cm with very low suspicion US...
...Nodules...
...Nodules
...outine TSH suppression therapy for benig...
...idual patients with benign, solid or mostl...
...) Surgery may be considered for growing nodules th...
...Patients with growing nodules that are benign...
...Recurrent cystic thyroid nodules with benign cytol...
...ere are no data to guide recommendatio...
...of clinically relevant thyroid nodule...
...B) For women with suppressed serum TSH levels...
31. A) PTC discovered by cytology...
...B) In pregnant women with FNA that is suspici...