Thyroid Nodules and Differentiated Thyroid Cancer Thyroid Nodules
Key Points
Key Points
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
...agnosis
...eople with familial follicular cell-derived differ...
...rum TSH should be measured during the init...
...f the serum TSH123 is subnormal, a radionuclide (p...
C) If the serum TSH is normal or elevat...
...utine measurement of serum Tg for initial eval...
...cannot recommend either for or against routine mea...
...18FDG-PET uptake within a sonographicall...
...Diffuse 18FDG-PET uptake, in conjunctio...
...ography with survey of the cervical ly...
7. FNA is the procedure of choice in the eva...
A) Nodules >1cm in greatest dimensio...
...Nodules >1 cm in greatest dimension...
...Nodules >1.5 cm in greatest dimension with low...
...iagnostic FNA may be considered for (Figure 2, Ta...
...le diagnostic FNA is not required for (Figure 2, T...
...that are purely cystic. (SR,...
...le FNA cytology should be reported...
...ule with an initial nondiagnostic cytolog...
...B) Repeatedly nondiagnostic nodules...
...should be considered for histopathol...
...ule is benign on cytology, further immediate diag...
...logy result is diagnostic for primar...
...lecular testing is being considere...
...tended for clinical use, molecular...
...es with AUS/FLUS cytology, after consideratio...
...f repeat FNA cytology and/or molecular testing a...
16. A) Diagnostic surgical excisio...
...molecular testing is either not performed or in...
...the cytology is reported as suspi...
...nsideration of clinical and sonographic featu...
...maging is not routinely recommended for...
...tion and Management of Patients With Thyroid Nodu...
...ATA Nodule Sonographic Patterns and...
Figure 3. Lymph Node Compartments Sep...
.... Sonographic Patterns, Estimated Risk...
Treatment
...eatment...
...ry is considered for patients with a solitary, cy...
...e of increased risk for malignancy, total t...
...s with indeterminate nodules who have bilate...
...ents with multiple thyroid nodules >1 cm shou...
...1. B) When multiple nodules >1 cm are...
...) If none of the nodules has a high or mo...
22. A low or low-normal serum TSH123 co...
...es with high suspicion US pattern: repea...
...s with low to intermediate suspicion...
...very low suspicion US pattern (incl...
...th high suspicion US pattern: repeat U...
...th sonographic features of low to inter...
...odules >1 cm with very low suspicion US pattern...
...Nodules...
...) Nodules
...ine TSH suppression therapy for benign t...
...patients with benign, solid or mostly solid no...
...Surgery may be considered for growing nodules t...
...atients with growing nodules that are benign afte...
...nt cystic thyroid nodules with benign cytology...
...e are no data to guide recommendat...
30. A) FNA of clinically relevant...
...0. B) For women with suppressed serum TSH le...
...PTC discovered by cytology in early...
...n pregnant women with FNA that is suspicious...