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Thyroid Noudle
 

Thyroid Noudle

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    Thyroid Noudle Thyroid Noudle Presentation Transcript

    • Thyroid Nodules
    • Thyroid Nodules
      • Prevalence and incidence
      • Palpable nodules: 4-7 % of the population
      • Incidentally on US: almost 50 %,
      • 75 % multi nodular, 25 % solitary
      • Thyroid cancer: 5-10 % of palpable nodules
      • The main objective of evaluating thyroid nodules is to
      • exclude malignancy
    • Type of thyroid nodules Cyst : simple cyst, mixed cystic-solid Colloid nudule : dominant nodule in MNG Adenoma : Follicular, Hurthle cell, Atypical Thyroiditis : Hashimoto’s, subacute Infection : Granulomatous disease, Abscess Developmental anomalies : unilateral lobe agenesis, cystic hygroma, Dermoid, Teratoma Carcinoma : papillary ( 75 %), follicular ( 5-10 %), medullary ( 5-10 %) , anaplastic ( 5 %), lymphoma ( 5 %), metastatic
    • Factors associated with increase risk for malignant thyroid nodule
      • History (moderate increase risk)
          • Age < 20 or > 60 years
          • Male sex
          • Exposure of RT (especially in childhood)
          • F.Hx of thyroid cancer or polyposis
      • Physical finding (highly increase risk)
          • larger than 3 cm
          • Rapid tumor growth
          • Very firm nodule, irregular surface
          • Fixation to adjacent structure
          • Symptom of local invasion: dysphagia, hoarseness
          • Cervical lymphadenopathy
          • Cold nodule on thyroid scan
          • Solid or complex cyst on US
    • Factors suggesting benign thyroid nodule
      • F.Hx of autoimmune disease (Hashimoto’s thyroiditis)
      • F.Hx of benign thyroid nodule or goiter
      • Presense of thyroid hormone dysfunction,
      • hypothyroid or hyperthyroid
      • Pain or tenderness associated with nodule
      • Soft, smooth, mobile
      • MNG without a predominant nodule
      • Warm nodule on thyroid scan
      • Simple cyst on US
    • Investigation
      • Laboratory evaluation
        • TSH: screening for hyper or hypothyroid
        • T 3, T 4 : when TSH are low normal or high normal
        • Serum antithyroid peroxidase (anti-TPO),
      • antithyroglobulin (anti-Tg) if suspected thyroiditis
      • Imaging study
        • CT, MRI, PET: not cost-effective in initial evaluation of
      • thyroid nodule
        • Ultrasound: characters that increase risk for malignant;
      • ill defined margin, irregular shape, solid echo, hypoechoic ,
      • calcification (fine): sensitivity 75 %, specificity 61 %
        • Thyroid isotope scanning : 131 I , 123 I , 99 TC
              • cold nodule ( 84 %): cancer risk 15 %
              • warm nodule ( 10.5 %): cancer risk 9 %
              • hot nodule ( 5.5 %): cancer risk 1 %
        • T hyroxine suppression therapy with US follow up
      • sensitivity 83 %, specificity 33 %
    • US: A solitary hypoechoic nodule at Rt. Lobe thyroid Slide 12 Slide 12
    • Isotope scan : Left: Normal thyroid Right: A cold nodule Lt.lobe thyroid
    • Diagnostic procedure:
      • Fine needle aspiration cytology (FNA)
          • Sensitivity: 70-90 %, specificity 70-90 %
          • False negative result: 3-8 %
          • Reliability depend on:
              • Operator
              • Cytopathologist
              • Type of tumor: follicular neoplasm has
      • 20-30 % false negative rate
    • Thyroid Nodule TSH test Euthyroid Thyrotoxic Thyroid scan FNA Cold nodule Hot nodule 131 I or surgery Benign Suspicious Malignant Inadequate Observe or T 4 - Px Surgery Repeat FNA FU 6-12 M Suggested strategy for the management of thyroid nodules
    • Thyroid incedentalomas
      • Incidence: 30-60 % (Autopsy), 13-50 % (Ultrasound)
      • Size: usually < 1.5 cm
      • Incidence of cancer: < 5 %, mostly papillary CA
      Thyroid incedentaloma Hx. H+N RT, F.Hx. CA thyroid Positive Negative US guide FNA US finding Cytology Suspected Benign appearance Malignant or (< 1.5 cm) ( > 1.5 cm ) Observe Malignant Benign Surgery Observe
      • Frequency Malignant histology
      • Benign 60-65 % 3-8 %
      • Colloid or nodule goiter
      • Thyroiditis
      • Suspicious 10-15 % 20-30 %
      • Follicular neoplasm
      • Hurthle cell lesion
      • Cellular smear
      • Lymphoma
      • Malignant 3-5 % 95 %
      • Papillary
      • Medullary
      • Anaplastic
      • Inadequate 15 % 5 %
      • Techincal problem
      • Degernerative nodule
      • Hemorrhagic cyst
      Result of thyroid FNA interpretation
    • Colloid nodule : A: FNA B: Histopathology
    • Hoshimoto’s thyroiditis A: FNA B: Histopathology
    • Papillary carcinoma : A: FNA B: Histopathology
    • A: FNA B: Follicular adenoma C: Follicular carcinoma