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
...gnosis...
1. Screening people with familial follicular cell-...
...should be measured during the initial evaluation o...
...um TSH123 is subnormal, a radionuclide (pref...
...m TSH is normal or elevated, a radionu...
...measurement of serum Tg for initial evaluation of...
...e panel cannot recommend either for or ag...
...) Focal 18FDG-PET uptake within a sonographicall...
...Diffuse 18FDG-PET uptake, in conjunct...
...yroid sonography with survey of th...
...the procedure of choice in the evaluatio...
A) Nodules >1cm in greatest dimension with hi...
...1 cm in greatest dimension with intermediate suspi...
...cm in greatest dimension with low suspi...
...nodule diagnostic FNA may be consider...
...iagnostic FNA is not required for (Figure 2, Table...
...that are purely cystic. (SR, M)...
...Thyroid nodule FNA cytology should be repo...
...or a nodule with an initial nondia...
...dly nondiagnostic nodules without a high...
...rgery should be considered for histopatholo...
...1. If the nodule is benign on cytology,...
...If a cytology result is diagnostic for pr...
...lar testing is being considered, p...
...f intended for clinical use, molecula...
...odules with AUS/FLUS cytology, after c...
...If repeat FNA cytology and/or mole...
.... A) Diagnostic surgical excision is the long-est...
...lecular testing is either not performed or i...
...the cytology is reported as suspic...
...B) After consideration of clinical and sonog...
...18FDG-PET imaging is not routinely recommended fo...
.... Evaluation and Management of Patients With Thy...
...Nodule Sonographic Patterns and Risk of Ma...
...Node Compartments Separated into Lev...
...e 1. Sonographic Patterns, Estimated...
Treatment
...atment...
...9. When surgery is considered for patients w...
...ause of increased risk for malignan...
...0. B) Patients with indeterminate nodules...
...ts with multiple thyroid nodules >1 cm shoul...
...B) When multiple nodules >1 cm are pres...
.... C) If none of the nodules has a high or...
...2. A low or low-normal serum TSH123 concentr...
...with high suspicion US pattern: re...
...Nodules with low to intermediate suspicion US...
...les with very low suspicion US pattern (...
...es with high suspicion US pattern: repe...
...les with sonographic features of low to in...
...ules >1 cm with very low suspicion US pattern (in...
...Nodules
...) Nodules...
25. Routine TSH suppression therapy for ben...
...6. Individual patients with benign, solid or...
...ay be considered for growing nodules that ar...
...B) Patients with growing nodules that...
.... Recurrent cystic thyroid nodules with benign cyt...
.... There are no data to guide recommendatio...
...A) FNA of clinically relevant thyroid nodules sho...
30. B) For women with suppressed ser...
...A) PTC discovered by cytology in ear...
.... B) In pregnant women with FNA that...