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
...gnosis...
...reening people with familial follicul...
...uld be measured during the initial evalua...
...serum TSH123 is subnormal, a radionuclide (prefer...
...serum TSH is normal or elevated, a radionuclide...
...Routine measurement of serum Tg for initial...
...anel cannot recommend either for or ag...
...ocal 18FDG-PET uptake within a sonographica...
.... B) Diffuse 18FDG-PET uptake, in conj...
...id sonography with survey of the cervical lymph...
7. FNA is the procedure of choice in the evalu...
...m in greatest dimension with high suspici...
...Nodules >1 cm in greatest dimension with int...
...) Nodules >1.5 cm in greatest dimension with low...
...le diagnostic FNA may be considered for...
...hyroid nodule diagnostic FNA is not...
...les that are purely cystic. (SR, M)623...
...d nodule FNA cytology should be reported using di...
10. A) For a nodule with an initia...
...Repeatedly nondiagnostic nodules wi...
...urgery should be considered for his...
...he nodule is benign on cytology, further immediate...
...y result is diagnostic for primary...
...lar testing is being considered, patients should...
...ended for clinical use, molecular testing should...
...A) For nodules with AUS/FLUS cytolo...
...f repeat FNA cytology and/or molecular testing...
...iagnostic surgical excision is the long-establi...
...B) If molecular testing is either not performe...
17. A) If the cytology is reported as s...
...B) After consideration of clinical and sonogra...
...imaging is not routinely recommended for the e...
...uation and Management of Patients With Thyroid Nod...
...gure 2. ATA Nodule Sonographic Patterns an...
...Node Compartments Separated into Levels and...
...able 1. Sonographic Patterns, Estimated Risk of...
Treatment
Treatment
...hen surgery is considered for patients with...
...se of increased risk for malignancy, total...
20. B) Patients with indeterminate...
...A) Patients with multiple thyroid nodules >1 cm...
...ltiple nodules >1 cm are present, t...
...one of the nodules has a high or mod...
...A low or low-normal serum TSH123 concentration...
...Nodules with high suspicion US pattern: re...
...Nodules with low to intermediate suspici...
...with very low suspicion US pattern (...
A) Nodules with high suspicion US pattern: repea...
...with sonographic features of low to intermediate...
...odules >1 cm with very low suspicion US pattern...
...Nodules...
...Nodules...
.... Routine TSH suppression therapy...
...ndividual patients with benign, solid...
...rgery may be considered for growing...
...B) Patients with growing nodules t...
...t cystic thyroid nodules with benig...
...data to guide recommendations on the use of thy...
...of clinically relevant thyroid nodules should b...
...n with suppressed serum TSH levels...
...vered by cytology in early pregnancy shou...
...B) In pregnant women with FNA that is...