Thyroid Nodules and Differentiated Thyroid Cancer Thyroid Nodules

Publication Date: January 12, 2016

Key Points

Key Points

Epidemiologic studies have shown the prevalence of palpable thyroid nodules to be approximately 5% in women and 1% in men living in iodine-sufficient parts of the world. By contrast, high-resolution ultrasound (US) can detect thyroid nodules in 19–68% of randomly selected individuals, with higher frequencies in women and the elderly.

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

...Diagnosis

...Screening people with familial follicular...


...Serum TSH should be measured during t...

...he serum TSH123 is subnormal, a radion...

...If the serum TSH is normal or elevated, a rad...


...Routine measurement of serum Tg for i...


...panel cannot recommend either for or against routi...


5. A) Focal 18FDG-PET uptake within a sonogra...


...18FDG-PET uptake, in conjunction with sono...


...d sonography with survey of the cervical...


...rocedure of choice in the evaluatio...


...Nodules >1cm in greatest dimension with high...

...odules >1 cm in greatest dimension with inte...

...es >1.5 cm in greatest dimension with...

...id nodule diagnostic FNA may be con...

...diagnostic FNA is not required for (Figure 2...

...es that are purely cystic. (SR...


...nodule FNA cytology should be repor...


...odule with an initial nondiagnostic cytology res...


...Repeatedly nondiagnostic nodules without...


10. C) Surgery should be considered for h...


...e nodule is benign on cytology, fur...


...cytology result is diagnostic for primary t...


...lar testing is being considered, patients...


...intended for clinical use, molecular...


...) For nodules with AUS/FLUS cytology, after...


...f repeat FNA cytology and/or molec...


...) Diagnostic surgical excision is the long-esta...


...lecular testing is either not performed or inc...


...7. A) If the cytology is reported a...


...7. B) After consideration of clinical an...


...G-PET imaging is not routinely recommen...


...tion and Management of Patients With T...


...e 2. ATA Nodule Sonographic Patterns...


...Lymph Node Compartments Separated into Levels an...


.... Sonographic Patterns, Estimated Risk...


Treatment

.... When surgery is considered for patients with a...


...) Because of increased risk for malignancy, tota...


...ients with indeterminate nodules who...


...) Patients with multiple thyroid n...


...1. B) When multiple nodules >1 cm are...


...of the nodules has a high or moderate suspicio...


...A low or low-normal serum TSH123 c...


...h high suspicion US pattern: repeat USA) No...

...es with low to intermediate suspic...

...s with very low suspicion US pattern (includ...


...high suspicion US pattern: repeat US in...

...with sonographic features of low to interm...

...1 cm with very low suspicion US pattern (incl...

...Nodules...

...Nodules


...TSH suppression therapy for benign...


...dual patients with benign, solid or mostly soli...


...A) Surgery may be considered for g...


...B) Patients with growing nodules th...


...nt cystic thyroid nodules with benign c...


...o data to guide recommendations on th...


...linically relevant thyroid nodules should...


...For women with suppressed serum TSH levels...


...iscovered by cytology in early pregna...


...pregnant women with FNA that is suspicious...