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

...iagnosis

...eening people with familial follicul...


...erum TSH should be measured during the initial...

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

...the serum TSH is normal or elevated, a ra...


...measurement of serum Tg for initial e...


...el cannot recommend either for or aga...


...Focal 18FDG-PET uptake within a sonographic...


...FDG-PET uptake, in conjunction with sonograp...


...sonography with survey of the cervi...


...FNA is the procedure of choice in th...


...dules >1cm in greatest dimension with high suspic...

...>1 cm in greatest dimension with i...

...dules >1.5 cm in greatest dimensio...

...roid nodule diagnostic FNA may be consider...

Thyroid nodule diagnostic FNA is not requ...

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


...hyroid nodule FNA cytology should be...


...ule with an initial nondiagnostic c...


...peatedly nondiagnostic nodules without a high...


...hould be considered for histopathologic diagnosis...


...dule is benign on cytology, further immediate...


...cytology result is diagnostic for primary thyro...


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


.... If intended for clinical use, molecula...


15. A) For nodules with AUS/FLUS cytol...


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


.... A) Diagnostic surgical excision is...


...molecular testing is either not pe...


...the cytology is reported as suspici...


...) After consideration of clinical a...


...FDG-PET imaging is not routinely recom...


...luation and Management of Patients...


...Nodule Sonographic Patterns and Risk of Malign...


...Lymph Node Compartments Separated into...


...onographic Patterns, Estimated Risk...


Treatment

...eatment...

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


...use of increased risk for malignancy, total t...


...ients with indeterminate nodules who have bila...


...Patients with multiple thyroid nodules >1 cm shou...


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


...e of the nodules has a high or moderate su...


...low or low-normal serum TSH123 concen...


...es with high suspicion US pattern: repeat USA...

...) Nodules with low to intermediate s...

...ith very low suspicion US pattern (includin...


...odules with high suspicion US pattern: repeat...

...with sonographic features of low...

...with very low suspicion US pattern...

...Nodules...

E) Nodule...


...Routine TSH suppression therapy fo...


...ual patients with benign, solid or mostl...


...y may be considered for growing nodules that...


27. B) Patients with growing nodules that are...


...cystic thyroid nodules with benign cytolog...


29. There are no data to guide rec...


...NA of clinically relevant thyroid nodules s...


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


...PTC discovered by cytology in early preg...


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