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Thyroid nodules: diagnosis and management.

Rosemary Wong1, Stephen G Farrell2, Mathis Grossmann2

  • 1Eastern Health, Melbourne, VIC mathisg@unimelb.edu.au.

The Medical Journal of Australia
|July 13, 2018
PubMed
Summary
This summary is machine-generated.

Thyroid nodules require assessment for function, mass effect, and cancer risk. Key steps include history, TSH levels, ultrasound, and fine-needle aspiration (FNA) for accurate diagnosis and management.

Keywords:
Thyroid diseases

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Area of Science:

  • Endocrinology
  • Oncology
  • Radiology

Background:

  • Thyroid nodules are prevalent, necessitating evaluation for thyroid function, potential mass effect, and malignancy.
  • Thyroid cancer occurs in 7-15% of nodules, highlighting the importance of accurate risk stratification.

Purpose of the Study:

  • To outline a comprehensive approach for assessing thyroid nodules.
  • To guide the appropriate use of diagnostic tools and management strategies for thyroid nodules.

Main Methods:

  • Assessment involves clinical evaluation, serum TSH measurement, thyroid ultrasonography, and fine-needle aspiration (FNA) when indicated.
  • Thyroid scans are used for suppressed TSH to differentiate nodule types; ultrasonography is reserved for palpable nodules by specialists.
  • FNA is considered for nodules ≥ 1.0 cm with risk factors, with results interpreted using the Bethesda Classification System.

Main Results:

  • Suppressed TSH suggests a thyroid scan to identify hot nodules or other conditions; cold nodules are managed similarly to normal TSH levels.
  • Routine thyroid cancer screening is not advised unless high-risk; early detection does not improve survival.
  • Molecular analysis of indeterminate FNA samples may improve benign/malignant discrimination.

Conclusions:

  • Management decisions for thyroid nodules are based on FNA results, clinical risk, and symptoms.
  • Surgery is indicated for confirmed malignancy, high-risk indeterminate cytology, suspected malignancy, significant mass effect, or thyrotoxicosis.