Thyroid nodules

Abstract

Thyroid nodules are common entities, clinically important primarily because of their malignant potential. Serum thyrotropin and thyroid ultrasonography are pivotal in evaluating thyroid nodules. Fine-needle aspiration biopsy is the most accurate tool for diagnosing malignancy and selecting candidates for surgery. An approach to the initial evaluation and management of single nodules, functioning nodules, multinodular glands, incidental nodules, and cysts is discussed, as are therapeutic interventions for benign nodules. Thyroid cancer discovered during pregnancy is also discussed.

Copyright © 2012 Elsevier Inc. All rights reserved.

Figures

Fig. 1

Diagnostic studies available for evaluating thyroid nodules. (Modified from figure provided by Dr BR Haugen, University of Colorado at Denver and Health Sciences Center, Aurora, CO; with permission.)

Fig. 2

Algorithm for initial evaluation of a patient with thyroid nodule. (Modified from Cooper DS. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19(11):1167–214; with permission.)

Fig. 3

US image of a thyroid nodule (arrowheads) containing multiple fine punctuate echo-genicities (arrow) with no comet-tail artifact, indicating high suspicion for malignancy. FNA and surgery confirmed PTC. (Reproduced from Frates MC. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology 2005;237:794–800; with permission.)

Fig. 4

Color Doppler US of a thyroid nodule showing marked internal vascularity, indicating increased likelihood of malignancy. Histology demonstrated PTC. (Reproduced from Frates MC. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology 2005;237:794–800; with permission.)

Fig. 5

US image of a cystic thyroid nodule (arrowheads). (Reproduced from Frates MC. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology 2005;237:794–800; with permission.)

Fig. 6

Algorithm for follow-up of benign thyroid nodules.