Thyroid Nodules

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Presentation :

First test for TSH:
- Low TSH → obtain radioisotope scan scintigraphy to confirm the diagnosis of autonomously functioning thyroid adenoma and to rule out additional nonfunctioning nodules.
- Normal or high TSH → obtain ultrasonography.
FNAB is indicated for:
- all thyroid nodules >1 cm with suspicious sonographic features and a normal TSH level
- nodules <1 cm in patients with risk factors for thyroid cancer or suspicious ultrasound characteristics
In patients with multinodular goiter, the risk for malignancy is the same for multiple nodules as it is for a solitary nodule; therefore, evaluation and management are identical.
Follow benign nodules with periodic ultrasonography. Malignancy must be ruled out when a nodule increases in size or if a nodule develops concerning ultrasound characteristics.

Radioactive iodine or surgery: Treat hyperfunctioning solitary thyroid nodules with radioactive iodine ablation or hemithyroidectomy.
Surgery is indicated for patients with:
- continued nodule growth despite normal initial FNAB results
- nondiagnostic results on repeat FNAB
- malignant cytology
- large multinodular goiters with compressive symptoms