Thyroid nodule - Wikipedia, the free encyclopedia

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Thyroid nodule
From Wikipedia, the free encyclopedia

Thyroid nodules are lumps which

commonly arise within an otherwise

Thyroid nodule

normal thyroid gland.[1] They

indicate a thyroid neoplasm, but only
a small percentage of these are
thyroid cancers.

Contents
1 Presentation
2 Diagnosis
2.1 Fine needle biopsy
2.2 Blood tests
2.3 Imaging
3 Malignancy
4 Solitary thyroid nodule
4.1 Risks for cancer
4.2 Signs and
symptoms
4.3 Investigations
4.4 Thyroid scan
4.5 Surgery
4.6 Treatment
5 See also
6 References

Human thyroid with cancer nodules

Classification and external resources
ICD-10

E04.1
(http://apps.who.int/classifications/icd10/browse/2015/en#/E04.1)

ICD-9

241.0 (http://www.icd9data.com/getICD9Code.ashx?icd9=241.0)

DiseasesDB 5332 (http://www.diseasesdatabase.com/ddb5332.htm)

MedlinePlus 007265
(http://www.nlm.nih.gov/medlineplus/ency/article/007265.htm)
eMedicine

med/3224 (http://www.emedicine.com/med/topic3224.htm)

MeSH

D016606 (https://www.nlm.nih.gov/cgi/mesh/2015/MB_cgi?
field=uid&term=D016606)

Presentation
Often these abnormal growths of thyroid tissue are located at the edge of the thyroid gland and can be felt as a
lump in the throat. When they are large or when they occur in very thin individuals, they can sometimes be seen
as a lump in the front of the neck.
Sometimes a thyroid nodule presents as a fluid-filled cavity called a thyroid cyst. Often, solid components are
mixed with the fluid. Thyroid cysts most commonly result from degenerating thyroid adenomas, which are
benign, but they occasionally contain malignant solid components.[2]

Diagnosis

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After a nodule is found during a physical examination, a referral to an endocrinologist, a thyroidologist or

otolaryngologist may occur. Most commonly an ultrasound is performed to confirm the presence of a nodule,
and assess the status of the whole gland. Measurement of thyroid stimulating hormone and anti-thyroid
antibodies will help decide if there is a functional thyroid disease such as Hashimoto's thyroiditis present, a
known cause of a benign nodular goiter.[3] Fine needle biopsy for histopathology is also used.[4][5]
Thyroid nodules are extremely common in young adults and children. Almost 50% of people have had one, but
they are usually only detected by a physician during the course of a health examination or fortuitously
discovered during the investigation of an unrelated condition.[6]

Fine needle biopsy

One approach used to determine whether the nodule is malignant is the fine needle biopsy (FNB),[7] which
some have described as the most cost-effective, sensitive and accurate test.[8][9] FNB or ultrasound-guided FNA
usually yields sufficient thyroid cells to assess the risk of malignancy, although in some cases, the suspected
nodule may need to be removed surgically for pathological examination. The report may be done according to
the Bethesda System for Reporting Thyroid Cytopathology.

Blood tests
Blood or imaging tests may be done prior to or in lieu of a biopsy. The possibility of a nodule which secretes
thyroid hormone (which is less likely to be cancer) or hypothyroidism is investigated by measuring thyroid
stimulating hormone (TSH), and the thyroid hormones thyroxine (T4) and triiodothyronine (T3).
Tests for serum thyroid autoantibodies are sometimes done as these may indicate autoimmune thyroid disease
(which can mimic nodular disease).

Imaging
The blood assays may be accompanied by ultrasound imaging of the
nodule to determine the position, size and texture, and to assess whether
the nodule may be cystic (fluid filled). Also suspicious findings in a
nodule are hypoechoic,[10] irregular borders, microcalcifications, or very
high levels of blood flow within the nodule. Less suspicious findings in
benign nodules include, hyperechoic, comet tail artifacts from colloid,
no blood flow in the nodule and a halo, or smooth border.
Nuclear medicine can be used to image the thyroid with radioactive
technetium (Tc) or iodine (I) imaging of the thyroid.[11] An 123I scan
showing a hot nodule, accompanied by a lower than normal TSH, is
strong evidence that the nodule is not cancerous.

Comet tail artifacts from colloid.

Malignancy
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Only a small percentage of lumps in the neck are malignant (around 4 6.5%[12]), and most thyroid nodules are
benign.
There are many factors to consider when diagnosing a malignant lump. Trouble swallowing or speaking,
swollen cervical lymph nodes or a firm, immobile nodule are more
indicative of malignancy, whereas a family history of autoimmune
disease or goiter, thyroid hormonal dysfunction or a soft, painful nodule
are more indicative of benignancy.
The prevalence of cancer is higher in males, patients under 20 years old
or over 70 years old, and patients with a history of head and neck
irradiation or a family history of thyroid cancer.[13]

Solitary thyroid nodule

Risks for cancer
Thyroid scan

Solitary thyroid nodules are more common in females yet more

worrisome in males. Other associations with neoplastic nodules are family history of thyroid cancer and prior
radiation to the head and neck.
Radiation exposure to the head and neck may be for historic indications such as tonsillar and adenoid
hypertrophy, "enlarged thymus", acne vulgaris, or current indications such as Hodgkin's lymphoma. Children
living near the Chernobyl nuclear power plant during the catastrophe of 1986 have experienced a 60-fold
increase in the incidence of thyroid cancer. Thyroid cancer arising in the background of radiation is often
multifocal with a high incidence of lymph node metastasis and has a poor prognosis.

Signs and symptoms

Worrisome sign and symptoms include voice hoarseness, rapid increase in size, compressive symptoms (such as
dyspnoea or dysphagia) and appearance of lymphadenopathy.

Investigations
TSH A thyroid-stimulating hormone level should be obtained first. If it is suppressed, then the nodule is
likely a hyperfunctioning (or "hot") nodule. These are rarely malignant.
FNAC fine needle aspiration cytology is the investigation of choice given a non-suppressed TSH.
Repeat the FNAC in 6 months if the nodule enlarges.
Imaging Ultrasound and radioiodine scanning.

Thyroid scan
Cold 85% of nodules are cold. 58% of cold and warm nodules are malignant.[14]
Hot 5% of nodules are hot. Malignancy is virtually nonexistent in hot nodules.[15]

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Surgery
Surgery is indicated in the following instances:
Reaccumulation of the nodule despite 34 repeated FNACs
Size in excess of 4 cm in some cases
Compressive symptoms
Signs of malignancy (vocal cord dysfunction, lymphadenopathy)

Treatment
Levothyroxine is a stereoisomer of thyroxine which is degraded much slower and can be administered once
daily in patients with hypothyroidism.

See also
Thyroid adenoma
Colloid nodule

References

Wikimedia Commons has

media related to Thyroid
nodule.

1. "New York Thyroid Center: Thyroid Nodules"

(http://www.cumc.columbia.edu/dept/thyroid/nodules.html).
2. mayoclinic.com > Thyroid nodules (http://www.mayoclinic.com/health/thyroid-nodules/DS00491/DSECTION=causes)
Feb. 22, 2011
3. Bennedbaek FN, Perrild H, Hegeds L (1999). "Diagnosis and treatment of the solitary thyroid nodule. Results of a
European survey" (http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=03000664&date=1999&volume=50&issue=3&spage=357). Clin. Endocrinol. (Oxf) 50 (3): 35763. doi:10.1046/j.13652265.1999.00663.x (https://dx.doi.org/10.1046%2Fj.1365-2265.1999.00663.x). PMID 10435062
(https://www.ncbi.nlm.nih.gov/pubmed/10435062).
4. Ravetto C, Colombo L, Dottorini ME (2000). "Usefulness of fine-needle aspiration in the diagnosis of thyroid
carcinoma: a retrospective study in 37,895 patients". Cancer 90 (6): 35763. doi:10.1002/10970142(20001225)90:6<357::AID-CNCR6>3.0.CO;2-4 (https://dx.doi.org/10.1002%2F10970142%2820001225%2990%3A6%3C357%3A%3AAID-CNCR6%3E3.0.CO%3B2-4). PMID 11156519
(https://www.ncbi.nlm.nih.gov/pubmed/11156519).
5. "Thyroid Nodule" (http://www.meddean.luc.edu/lumen/MedEd/medicine/endonew/thyrndl/thyrdndl.htm).
6. Russ G (Sep 2014). "Thyroid incidentalomas: epidemiology, risk stratification with ultrasound and workup". European
Thyroid Journal 3: 15463. doi:10.1159/000365289 (https://dx.doi.org/10.1159%2F000365289). PMID 25538897
(https://www.ncbi.nlm.nih.gov/pubmed/25538897).
7. Ravetto C, Colombo L, Dottorini ME (2000). "Usefulness of fine-needle aspiration in the diagnosis of thyroid
carcinoma: a retrospective study in 37,895 patients". Cancer 90 (6): 35763. doi:10.1002/10970142(20001225)90:6<357::AID-CNCR6>3.0.CO;2-4 (https://dx.doi.org/10.1002%2F10970142%2820001225%2990%3A6%3C357%3A%3AAID-CNCR6%3E3.0.CO%3B2-4). PMID 11156519
(https://www.ncbi.nlm.nih.gov/pubmed/11156519).
8. Hamberger, B (1982). "Fine-needle aspiration biopsy of thyroid nodules. Impact on thyroid practice and cost of care".
Am J Med 73 (3): 381384. doi:10.1016/0002-9343(82)90731-8 (https://dx.doi.org/10.1016%2F00029343%2882%2990731-8). PMID 7124765 (https://www.ncbi.nlm.nih.gov/pubmed/7124765).
9. Mazzaferri (1993). "Management of a Solitary Thyroid Nodule". N Engl J Med 328 (8): 5539.
doi:10.1056/NEJM199302253280807 (https://dx.doi.org/10.1056%2FNEJM199302253280807). PMID 8426623
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(https://www.ncbi.nlm.nih.gov/pubmed/8426623).
Wong KT, Ahuja AT (2005). "Ultrasound of thyroid cancer" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1665239).
Cancer Imaging 5: 15766. doi:10.1102/1470-7330.2005.0110 (https://dx.doi.org/10.1102%2F1470-7330.2005.0110).
PMC 1665239 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1665239). PMID 16361145
(https://www.ncbi.nlm.nih.gov/pubmed/16361145).
Nuclear Medicine Thyroid Scan - MedlinePlus Medical Encyclopedia
http://www.nlm.nih.gov/medlineplus/ency/article/003829.htm
http://www.uptodate.com/contents/diagnostic-approach-to-and-treatment-of-thyroid-nodules?
source=search_result&search=thyroid+nodule&selectedTitle=1%7E100
http://emedicine.medscape.com/article/127491-overview#aw2aab6b3
Gates JD, Benavides LC, Shriver CD, et al. Preoperative thyroid ultrasound in all patients undergoing
parathyroidectomy?. J Surg Res. Dec 4 2008;[Medline].
Robbins pathology 8ed page 767

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