The thyroid nodule--evaluation and management.
Thyroid nodules are common; with the growing availability of sensitive TSH assays, fine needle aspiration biopsy (FNAB) and high resolution ultrasonography (HRUSG), thyroid nodules are being increasingly recognised, diagnosed and treated. The diagnosis of a thyroid nodule is associated with considerable anxiety for the patient; a systematic approach, by excluding the possibility of malignancy, helps allay such anxiety. Nodules are sometimes picked up on neck imaging for non-thyroid conditions; these so-called 'incidentalomas' also need evaluation to rule out malignancy. A sensitive TSH assay is usually the first investigation; a suppressed TSH level leading to a radionuclide scan and an FT4 level to detect toxic nodules that are best managed by radio-iodine or surgical ablation. Thyroid peroxidase antibody is estimated if the TSH level is high. Palpable nodules in euthyroid subjects are best evaluated by HRUSG followed by USG-guided FNA. For nodules <10 mm size, USG-guided FNA is recommended only if clinical or USG features are suspicious. While the benign nodules are kept under regular follow-up, all malignant nodules should be removed surgically. Cystic thyroid lesions are well managed by percutaneous ethanol ablation. Routine measurement of serum calcitonin and other sub cellular markers is not recommended.
Chowdhury
Subhankar
S
Department of Endocrinology and Metabolism, IPGME&R and SSKM Hospital, Kolkata.
Mukherjee
Satinath
S
Mukhopadhyay
Sarmistha
S
Mazumder
Rachna
R
D044963:Biopsy, Fine-Needle; D000431:Ethanol / Q000627:therapeutic use; D006801:Humans; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D014463:Ultrasonography
D000431:Ethanol