Thyroid incident Loma

Prepared by :
Mohammed Sehweil

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‫مشرف منتدى العناية المركزة والقلب‬

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 Thyroid incident Loma is that
nodules which are small and non
palpable measuring between 1
mm- 15mm and are incidentally
discovered on ultrasound for
(neck, parathyroid, carotid) or
that discovered by autopsy studies
 Most incidentalomas from autopsy 30-60%
and they are discovered by highly resolution
ultrasound which is capable of detecting many
small nonpalpable thyroid nodule
 Most of thyroid nodules are benign, if there is
malignancy in the nodules they are called
microcarcinoma
 Most thyroid nodules which is located
posteriorly is very difficult to palpate
 1/3 of nodules more that 2 cm are detected
 Imaging studies
 US: save and sensitive and capable of
detecting lesion as small as 1-3 mm
 Sensitivity 90% specificity 84%
 Thyroid scintigraphy Tc99m : detect 40% of
thyroid incidentaloma on patient who had
clinically normal thyroid gland
 13% discovered incidental thyroid nodules of
carotid neck ultrasound
 40% of patient with hyperparathyroidism
where discovered to have thyroid
incidentalomas
 How should thyroid incidentaloma
managed
 Patient who have incidentaloma less than 15
mm and in patient with low risk of thyroid
cancer >> observation.
 Patients who have Hx of exposure to radiation
during childhood or those who have
ultrasonographic feature that suggest
malignancy >>> FNA should be done
 If that lesion was proven to be malignant >>
should be treated surgically
 Benign nodules should be followed up by
palpation at 6 months and annually thereafter.
 Patients who have nodules that smaller than 15
mm that have benign appearance on
ultrasonography >> annual neck palpation is
sufficient
 Ultrasound finding in malignant
lesions
 Hypoechogenicity
 Irregular margin
 Intranodular calcifications
 Increase vascularity (Doppler US)
 Abstract
 BACKGROUND: The clinical significance of
thyroid incidentalomas is controversial.
 METHODS: The rate of malignancy was determined
for patients with an incidentally discovered thyroid
nodule, and results were stratified according to
imaging modality as well as presence and type of pre-
existing malignancy.
 RESULTS: One hundred fifty patients were
identified, of which 88 with a known malignancy
were screened for metastases. Twenty-three (15%)
patients were diagnosed with thyroid malignancy.
 Incidental nodules identified on positron emission
tomography scan were malignant in 33% of the
patients compared with 11% for those identified on
computed axial tomography (P .016).
 The rate of thyroid malignancy in patients with pre-
existing nonthyroid malignancy (18%) was not
significantly different from patients without a history
of malignancy (13%, P .36).
 COMMENTS: Thyroid incidentalomas are
associated with a high rate of malignancy. The rate of
malignancy is highest for nodules discovered on
positron emission tomography scan and is no
different in patients with or without pre-existing
malignancy