SOLITARY THYROID NODULE

1. THYROID NEOPLASMS &
SOLITARY THYROID
NODULE
PREPARED BY : DR. MOHAMED ELWARFALLI
BMC,BENGHAZI-LIBYA
DEPARTMENT OF SURGERY
APRIL 5, 2018

2. Thyroid cancer is rare about 1% of malignancies but
nodules in thyroid gland relatively is common.

3. Thyroid nodule;
A discrete swelling within the thyroid gland that is
palpable or radiologically distinct from surrounding
thyroid parenchyma.
It is may be symptomatic or be an incidental finding .
Clinical examination can detect asymptomatic thyroid
nodule in about 5% of the population.
This figure is increased to 25% using Ultrasound.

4. In any patient with a solitary thyroid nodule ,
MALIGNANCY needs to be excluded by investigation,
and fine needle aspiration cytology or needle core
biopsy is the first step in doing so.
Less than 10% of true solitary nodules are malignant ,
this rises to about 40% in patient who have undergone
previous neck irradiation.

5. Common causes of Solitary thyroid nodule;
BENIGN
Thyroiditis
Multinodular goiter
Simple/ Hgic cyst
Follicular adenoma
MALIGNANT
Primary
Papillary thyroid cancer
Follicular thyroid cancer
Hurthle cell cancer
Anaplastic thyroid cancer
Medullary thyroid cancer
Thyroid lymphoma
Secondary
Metastatic cancer

6. Thyroid Neoplasm :
Thyroid gland contains follicular & parafollicular ( C ) cells.
Tumors of the thyroid gland can be classified as :
1. Tumors arising from follicular epithelium:
BENIGN Follicular adenoma.
MALIGNANT Differentiated Papillary carcinoma 80%
Follicular carcinoma 10%
Hurthle cell carcinoma 4%
Undifferentiated Anaplastic carcinoma 1%
2.Tumors from parafollicular ep. : Medullary carcinoma 5%
3.Tumors from lymphoid elements: Malignant lymphoma.
4.Rarely the thyroid gland infiltrated by metastatic deposits or by local
infiltration from a nearby lesion.

7. Presentation;
Benign and malignant thyroid nodules usually present as 1.
Neck LUMP
2. Painful swelling : *Hge. *Thyroiditis. *Malignancy.
3. Toxic manifestation in toxic nodules.
4. Criteria of malignancy in malignant nodules.
Other clinical manifestations are :
Neck discomfort , difficulty in swallowing or breathing ,
change in voice , History of rapid growth , cervical lymph
nodes.

8. Findings that raise suspicion of malignancy
in a solitary nodule:
1.History of previous irradiation.
2.Young and elderly patients.
3.Male sex.
4.F/H of MEN2.
5.Recent onset , and rapid growth.
6.Painful , Hard , Irregular nodule with limited mobility.
7.Local invasion or lymphatic , blood borne metastasis.

9. Clinical examination;
A complete physical examination is necessary , with
emphasis on the inspection and palpation of the neck ,
including the thyroid and the lymph node compartments in
the neck.

10. Investigations;
1. Suspicion of TOXICITY , Thyroid function tests are
performed.
2. Calcium , calcitonin , thyroglobulin, Autoantibody status
should be checked.
3. Thyroid isotope scan.
4.Ultrasound ; differentiate b/w a cyst and solid nodule.
5. FNAC ; simple, fast, inexpensive but can’t differentiate b/w
follicular adenoma and follicular carcinoma.
6. True cut needle biopsy.
7. Excision biopsy ; the surest method of diagnosis is to do
lobectomy of the affected side and then frozen section.

13. Treatment scheme :
a. Multiple : Subtotal
thyroidectomy.
b. Solitary :
1. CYSTIC : aspiration = Simple
cyst OR suspicion of
Malignancy ( ttt accordingly ).
2. Solid : Thyroid scan =
-HOT = Toxic nodule.
-Warm = adenoma (hem-
thyroidectomy & biobsy)
-COLD = biobsy , Benign (
hemi-thyroidectomy ) .
Malignant ( treat
accordingly ).

14. Pathological variants of malignant
neoplasms :
Papillary thyroid carcinoma ;
-Commonest form thyroid carcinoma.
-Children & young adult.
-Psammoma bodies
-Lymphatic spread
-Positive prognosis
-Pulmonary metastases.
Treatment :
Total thyroidectomy.
Post operative L-thyroxine 0.2mg/day.

15. Follicular thyroid carcinoma ;
-Middle age female
-FNA can’t diagnose cancer
-Capsular or vascular invasion
-Mainly blood spread
-Favorable prognosis
Treatment:
Total thyroidectomy.
Post op. L-thyroxine.

16. Anaplastic carcinoma ;
-Uncommon 1% .
-Elderly.
-Aggressive , prognosis poor ( most patients die within 1 year
-Spindle cells , Giant cells
-Mainly direct invasion, Lymphatic or blood spread.
Treatment:
Small tumor : Total thyroidectomy + XRT/Chemo
Large tumor : Debulking surgery and tracheostomy,
XRT/Chemo.

17. Medullary carcinoma ;
-Rare tumor.
-Sporadic or familial (children and young adult).
-MEN2, secrete calcitonin.
-Hyaline stroma contain amyloid material.
-Lymphatic/Blood spread.
Treatment :
Total thyroidectomy and L.N resection.

18. Lymphoma :
-Arise in a pre-existing longstanding Hashimoto’s thyroiditis.
-Elderly woman.
Treatment:
XRT / Chemo.