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

...gnosis...

...ople with familial follicular cell-derived dif...


...should be measured during the initial e...

...rum TSH123 is subnormal, a radionuclide (pref...

C) If the serum TSH is normal or elevated...


3. Routine measurement of serum Tg...


.... The panel cannot recommend either for or...


...DG-PET uptake within a sonographically confirm...


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


...Thyroid sonography with survey of the cervical ly...


.... FNA is the procedure of choice i...


A) Nodules >1cm in greatest dimension with high s...

...1 cm in greatest dimension with interm...

...>1.5 cm in greatest dimension with low suspicio...

...id nodule diagnostic FNA may be co...

...e diagnostic FNA is not required for (Figure 2, Ta...

...that are purely cystic. (SR, M)623...


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


...For a nodule with an initial nondiagnostic c...


...peatedly nondiagnostic nodules without...


...ery should be considered for histopathologic dia...


...he nodule is benign on cytology, further immediat...


...a cytology result is diagnostic for...


...lecular testing is being considere...


...ended for clinical use, molecular testin...


...les with AUS/FLUS cytology, after considerati...


...eat FNA cytology and/or molecular te...


...stic surgical excision is the long-estab...


...If molecular testing is either not per...


.... A) If the cytology is reported as suspi...


...nsideration of clinical and sonogra...


...imaging is not routinely recommende...


...Evaluation and Management of Patie...


...ure 2. ATA Nodule Sonographic Patterns and Risk of...


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


...1. Sonographic Patterns, Estimated Risk of Mal...


Treatment

...eatment

...n surgery is considered for patients with a soli...


...of increased risk for malignancy, total thyroid...


...B) Patients with indeterminate nodules...


...s with multiple thyroid nodules >1 cm shoul...


...When multiple nodules >1 cm are present, thos...


.... C) If none of the nodules has a high or m...


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


...odules with high suspicion US pattern...

B) Nodules with low to intermediate suspicio...

...dules with very low suspicion US pattern (inc...


...les with high suspicion US pattern: rep...

...ith sonographic features of low to intermediate s...

...les >1 cm with very low suspicion US pattern (inc...

...Nodules

...) Nodules...


...suppression therapy for benign thyroid nodules i...


...atients with benign, solid or mostly so...


...A) Surgery may be considered for growing nodules...


...s with growing nodules that are be...


...rrent cystic thyroid nodules with...


...There are no data to guide recommendatio...


...FNA of clinically relevant thyroid n...


...or women with suppressed serum TSH levels that...


...A) PTC discovered by cytology in early pregnanc...


...nt women with FNA that is suspicious...