Evaluation of Thyroid Nodule

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"Evaluation of Thyroid Nodule"

If a 45 years women comes to you with swelling in the neck and by examination you identify that it is a thyroid nodule then what will be the next approach?

 

First of all come to that the diagnosis of a thyroid nodule may be

  

1.Toxic adenoma

2.Benign tumour

3.Malignant tumour

4.Follicular Neoplasm

5.Diffuse enlargement of a single lobe

6.Undiagnostic

So,what will be the approach??

First of all we should advice for TSH(Thyroid Stimulating Hormone)

         If it is decreased then it may be toxic adenoma.We will confirm it by doing a thyroid scan where the nodule will take the contrast intensely and the surrounding tissue will not.In this case Surgery or radioiodine therapy is the treatment option.

     If TSH increased then  we should advice for antihyroid antibody,if it is positive then it is a case of Autoimmune Thyroiditis & treatment is thyroid hormone replacement.

 

      If TSH is normal then and the tumour size is 1-1.5 cm then we should go for "Fine Needle aspiration  Biopsy  and the findings may be

         

*Benign tumor: Treatment option is wait and see.Surgery is the option when there is symptom due to compression, cosmetic purpose.

     

  *Malignant Tumour: It may be Papillary thyroid carcinoma,Medullary thyroid carcinoma,Thyroid lymphoma,Anaplastic thyroid carcinoma. Treatment option for first two type is Surgery and for the last two types radiotherapy and chemotherapy is the treatment option.

* Suspected Follicular Neoplasm: For this we can give hormone suppression therapy and monitor the size of the nodule,or can do surgery to make definite Diagnosis.

 * If Fine Needle aspiration Biopsy is undiagnostic, unsatisfactory then go for Ultrasono guided Fine Needle aspiration Biopsy