Thyroid Nodule
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This document describes a case of an interesting thyroid nodule found in a 66-year-old male with a history of multinodular goiter. Further testing found the nodule to be a clear cell carcinoma, matching the histology of a renal carcinoma the patient had surgically removed 25 years prior. Metastatic tumors to the thyroid gland can occur even many years after treatment of the primary cancer. Given the patient's history of renal cancer, the new thyroid nodule was determined to likely represent a metastatic deposit to the thyroid from the previous renal carcinoma. This case highlights the importance of considering metastasis when new thyroid masses present in patients with a history of other malignancies.
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Management Of Solitary Thyroid Nodule
This document discusses the management of solitary thyroid nodules. It defines thyroid nodules and states that 12-28% of nodules are malignant. A thorough clinical evaluation and tests like FNAC, thyroid function tests, thyroid scintiscan, and ultrasound can help determine if a nodule is benign or malignant. For nodules found to be malignant through these tests, total thyroidectomy is recommended. For nodules deemed benign, conservative treatment like TSH suppression is usually sufficient. Hemithyroidectomy may be considered for indeterminate or suspicious nodules.
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This document discusses solitary thyroid nodules (STNs), which are discrete swellings in an otherwise impalpable thyroid gland. STNs have a 10-15% risk of malignancy. They can be caused by conditions like thyroid adenomas, cysts, or carcinomas. Evaluation involves a history, exam, labs, ultrasound, scan, and FNAC. FNAC is the most useful test, but cannot always distinguish benign from malignant follicular lesions. Treatment depends on findings but may include observation, surgery, or radioiodine.
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- Thyroid imaging with ultrasound and radioactive iodine uptake scans can identify high-risk features that increase the likelihood of malignancy, such as hypoechogenicity, microcalcifications, irregular shape, and lack of iodine uptake in the nodule.
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supervised By/ Dr .nasser Zaghloul
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- Thyroid nodules are very common, found in 4-7% of people on physical exam and almost 50% on ultrasound, with most people having multiple nodules. Thyroid cancer is found in 5-10% of palpable nodules.
- Factors that increase cancer risk include nodule size over 3 cm, male sex, radiation exposure, family history of thyroid cancer, and symptoms of local invasion. Features suggesting benign nodules include a family history of autoimmune disease and benign nodules.
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The guidelines recommend FNA for:
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- Thyroid nodules are very common, found in 4-7% of people on physical exam and almost 50% on ultrasound, with most people having multiple nodules. Thyroid cancer is found in 5-10% of palpable nodules.
- Factors that increase cancer risk include nodule size over 3 cm, male sex, radiation exposure, family history of thyroid cancer, and symptoms of local invasion. Features suggesting benign nodules include a family history of autoimmune disease and benign nodules.
- Evaluation involves ultrasound, thyroid function tests, and fine needle aspiration of suspicious nodules, with surgery for nodules found to be malignant or indeterminate
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The guidelines recommend FNA for:
(A) Nodules >1cm in greatest dimension with high suspicion sonographic pattern.
(B) Nodules >1cm in greatest dimension with intermediate suspicion sonographic pattern.
II. Thyroid nodule diagnostic FNA may be considered for:
(A) Nodules 0.5-1cm with high suspicion sonographic pattern
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(C) Nodules showing significant growth over time (by ultrasound) even if none of the above criteria are met.
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- Thyroid cancer rates were 1 per 100,000 for males and 1.8 per 100,000 for females.
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1. Thyroid cancer is the most common endocrine malignancy, with papillary thyroid cancer being the most common type.
2. Treatment involves surgical removal of part or all of the thyroid gland followed by radioactive iodine ablation and thyroid hormone suppression.
3. Follow up care involves monitoring of thyroid levels and imaging tests to check for recurrence or spread of cancer. Outcomes depend on cancer type, stage, and individual risk factors.
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- Biopsy and surgery found multifocal follicular variant papillary carcinoma in both thyroid lobes, with the largest tumor being 3.3 cm. There was capsular invasion in the right lobe.
- Post-surgery, the patient underwent total thyroidectomy with central compartment and left modified radical neck dissection. A CT brain found a solitary metastatic brain lesion.
- The treatment plan involves discussing resection of the brain lesion with neurosurgery and performing a radioactive iodine whole body scan.
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This document summarizes guidelines from the 2015 American Thyroid Association for the management of thyroid nodules and differentiated thyroid cancer. It provides recommendations on the appropriate evaluation of thyroid nodules including laboratory tests, imaging, and fine needle aspiration biopsy. For thyroid nodules found on ultrasound, it recommends FNA based on the sonographic pattern and size of the nodule. It also provides guidance on the surgical and molecular testing approaches for indeterminate cytology results. The guidelines aim to inform clinicians on the best practices for diagnosing and treating patients with thyroid nodules.
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Solitary thyroid nodule ppt by dr koorapati ramesh
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Ueda2016 thyroid nodule in practice - khaled el hadidy
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Thyroid Nodule
- 1. An interesting thyroid noduleAn interesting thyroid nodule Dr Nidhi BhattDr Nidhi Bhatt St Georges Hospital May 2006
- 2. Case History 66 y, male Multinodular goitre- two nodules felt Long standing, painless No other history provided FNA Cellular follicular lesion Excision advised
- 3. Macroscopic specimen Lobectomy specimen 78g and 80x50x35 mm Lobulated surface Multiple nodules on C/S- Well-circumscribed Encapsulated Cream-coloured homogenous Occ. foci of haemorrhage
- 6. Clear cytoplasm, angulated nuclei, mild nuclear pleomorphism Fibrovascular stroma with delicate septa
- 7. Differential Diagnoses Clear cell change in 1º thyroid tumours Parathyroid neoplasms Metastatic renal clear cell carcinoma
- 8. Further steps Clinical correlation Histochemical stains Immunostains
- 9. Special stains PAS +/- diastase Thyroglobulin TTF-1 CAM CK7/20 Vimentin CD10 Calcitonin
- 10. TTF -Ve
- 11. CD10 +ve
- 12. Vimentin +ve
- 13. Other results Cytoplasmic PAS-positive globules CK7/ 20 -ve CAM 5.2 +ve Thyroglobulin -ve Calcitonin -ve Neuroendocrine markers -ve
- 14. Metastatic clear cellMetastatic clear cell renal carcinomarenal carcinoma
- 15. Case discussed at the head & neck MDT Renal tumour removed 25 years ago in 1984, diagnosed as Clear cell carcinoma, G2, pT2
- 16. Further Ix No metastases in other organs No lymph nodes Other kidney normal
- 17. Arch Pathol Lab Med 1998;122(1):37-41, Cancer 1997;79(3 Discussion Intrathyroidal mets do occur 0.6-1.2 % in thyroidectomies 0.5-24% at autopsy Most common primary sites Lung (16-43%) Kidney (5.5-33%) Breast (1-16%) Stomach (8%) Uterus (7%)
- 18. Contd… Average interval 0-19 years 25 years in the present case Prognosis depends on Primary site Completeness of resection Rx Thyroidectomy to avoid morbidity of tumour recurrence in neck
- 19. Moral of the story New thyroid mass in a patient with previous history of malignancy Think of metastatic deposits
- 20. When in doubt,When in doubt, take the case to MDMtake the case to MDM !!
- 21. References Chen H, Nicol TL, Udelsman R. Clinically significant, isolated metastatis disease to the thyroid gland. World J Surg 1999;23(2):177-80 Dequanter D, Lothaire P, Larsimont D etal. Intrathyroid metastasis:11 cases Ann Endocrinol (Paris) 2004;65(3):205-8 Lam KY, Lo CY. Metastatic tumours of the thyroid gland: a study of 79 cases in Chinese patients. Arch Pathol Lab Med 1998;122(1):37-41 Nakhjavani MK, Gharib H, Goelner JR, van Heerden JA. Metastasis to the thyroid gland. A report of 43 cases. Cancer 1997;79(3):574-8