DOCSLIB.ORG

Thyroid Nodules Update in Diagnosis and Management Shrikant Tamhane1* and Hossein Gharib2,3

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Thyroid Nodules Update in Diagnosis and Management Shrikant Tamhane1* and Hossein Gharib2,3 Tamhane and Gharib Clinical Diabetes and Endocrinology (2015) 1:11 DOI 10.1186/s40842-015-0011-7 REVIEW ARTICLE Open Access Thyroid nodules update in diagnosis and management Shrikant Tamhane1* and Hossein Gharib2,3 Abstract Thyroid nodules are very common. With widespread use of sensitive imaging in clinical practice, incidental thyroid nodules are being discovered with increasing frequency. Their clinical importance is primarily related to the need to exclude malignancy (4.0 to 6.5 percent of all thyroid nodules), assess for their functional status and any pressure symptoms caused by them. New Molecular tests are marketed for the assessment of thyroid nodules for the presence of cancer. The high prevalence of thyroid nodules requires evidence-based rational strategies for their differential diagnosis, risk stratification, treatment, and follow-up. This review addresses advances and controversies in thyroid nodule evaluation, including the new molecular tests, and their management considering the current guidelines and supporting evidence. Keywords: Thyroid, Thyroid Nodules, Molecular markers, Benign, Malignant, FNA, Management, Ultrasonography Introduction disorders, benign and malignant can cause thyroid nod- Thyroid nodule is a discrete lesion within the thyroid ules (Table 1) [1, 5]. gland that is radiologically distinct from the surrounding Fine needle aspiration (FNA) biopsy is the most accur- thyroid parenchyma. Thyroid nodules are common. ate method for evaluating thyroid nodules and helps to They are discovered as an accidental finding by a pa- identify patients who require surgical resection [6]. If a tient, or as an incidental finding during a routine phys- serum TSH is normal or elevated, and the nodule meets ical examination in 3 to 7 % [1] or by a radiologic criteria for sampling, the next step in the evaluation of a procedure: 67 % with ultrasonography (US) imaging, thyroid nodule is a FNA biopsy. Scintigraphy is use- 15 % with computed tomography (CT) or magnetic res- ful in patients with a low or suppressed serum TSH onance imaging (MRI) of the neck, and 1–2 % with concentration. fluorodeoxyglucose (FDG) positron emission tomog- *Work up of thyroid nodule algorithm is presented at raphy. Their clinical importance is primarily related to the end of the review. the need to exclude malignancy (4.0 to 6.5 percent of all thyroid nodules [1–4]), assess for their functional status and any pressure symptoms caused by them. History and physical examination With the discovery of a thyroid nodule, a complete his- tory and physical examination focusing on the thyroid Diagnosis gland and adjacent cervical lymph nodes should be per- Initial evaluation includes a history, physical examin- formed. Pertinent historical factors predicting malig- ation, and measurement of serum thyroid-stimulating nancy are included in Table 2 [1, 7]. hormone (TSH). Ultrasound is also recommended for Patients should also be asked about local pressure all patients to confirm the presence of nodule, define symptoms such as difficulty in swallowing or difficulty suspicious sonographic features and assess for the pres- in breathing. ence of additional nodules and lymphadenopathy. Many TSH * Correspondence: [email protected] 1Endocrinology and Metabolism, Rochester 55905MN, USA Thyroid function should be assessed in all patients with Full list of author information is available at the end of the article thyroid nodules. © 2015 Tamhane and Gharib. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Tamhane and Gharib Clinical Diabetes and Endocrinology (2015) 1:11 Page 2 of 9 Table 1 Benign and Malignant causes of thyroid nodules imaging studies (carotid ultrasound, CT, MRI, or 18- Benign fluorodeoxyglucose [FDG]-PET scan). Colloid nodule Thyroid ultrasonography is used to answer questions about the size and anatomy of the thyroid gland and ad- Hashimoto thyroiditis jacent structures in the neck. Simple or hemorrhagic cyst Sonographic characteristics of a thyroid nodule associated Follicular adenoma with a higher likelihood of malignancy include hypoecho- Subacute thyroiditis genicity, increased intranodular vascularity, irregular mar- Malignant gins, microcalcifications, absent halo, and a shape taller – Primary than wide measured in the transverse dimension [8 13]. A Papillary Thyroid Cancer (PTC) is generally solid or Follicular cell-derived carcinoma: predominantly solid and hypoechoic, often with infiltrative PTC, follicular thyroid carcinoma, anaplastic thyroid carcinoma irregular margins and increased nodular vascularity. Micro- C-cell–derived carcinoma: calcifications, if present, are highly specific for PTC, but may MTC be difficult to distinguish from colloid. Conversely, follicular Thyroid lymphoma cancer is more often iso- to hyperechoic and has a thick Secondary and irregular halo, but does not have microcalcifications [14]. Follicular cancers that are <2 cm in diameter have not Metastatic carcinoma (3 most common primaries are renal, lung & head-neck) been shown to be associated with metastatic disease [15]. Certain sonographic appearances may also be highly pre- dictive of a benign nodule. A pure cystic nodule, although rare (<2 % of all nodules), is highly unlikely to be malignant If the serum TSH concentration is low, indicating [12]. A spongiform appearance, defined as an aggregation overt or subclinical hyperthyroidism, the possibility that of multiple microcystic components in more than 50 % of the nodule is hyperfunctioning is increased and thyroid the nodule volume, is 99.7 % specific for identification of a scintigraphy should be performed next using either tech- benign thyroid nodule [13, 16, 17]. netium 99 mTc pertechnetate, or preferably, 123I. If the serum TSH concentration is normal or elevated, and the Scintigraphy nodule meets criteria for sampling as will be discussed Thyroid scintigraphy is used to determine the functional later, then FNA biopsy is indicated. status of a nodule. It should be performed in patients with a low serum TSH, indicating overt or subclinical hyperthyroidism. Ultrasonography Scintigraphy utilizes one of the radioisotopes of iodine Thyroid ultrasound US is noninvasive, relatively inexpen- (usually 123I) or technetium-99 m pertechnetate. If sive, and can identify nodules not apparent on physical available, radioiodine scanning is preferred. Normal thy- examination, isotope scanning, or other imaging tech- roid follicular cells take up both technetium and radioio- niques. It should be performed in all patients with a sus- dine, but only radioiodine is organified and stored (as pected thyroid nodule, a nodular goiter on physical thyroglobulin) in the lumen of thyroid follicles [18]. Both examination, or with nodules incidentally noted on other radioisotopes are less avidly concentrated by most be- nign and virtually all malignant thyroid nodules than ad- jacent normal thyroid tissue. Patients with nodules that Table 2 Increased risk of malignancy in thyroid nodule are functioning on pertechnetate imaging should – History of childhood head/neck irradiation undergo radioiodine imaging to confirm that they are – Total body irradiation for bone marrow transplantation [85] actually functioning [19, 20] as 5 percent of thyroid can- – Family history of PTC, MTC, or thyroid cancer syndrome (e.g., cers concentrate pertechnetate but not radioiodine [18]. Cowden’s syndrome, familial polyposis, Carney complex, multiple endocrine neoplasia [MEN] 2, Werner syndrome) in first degree relative Nonfunctioning – Young age Nonfunctioning nodules with uptake less than surround- – Male sex ing thyroid tissue may require further evaluation by FNA. – Enlarging nodule – Abnormal cervical adenopathy Autonomous Autonomous nodules may appear hot (uptake is greater – Fixed nodule than surrounding thyroid tissue) if they are hyperfunc- – Vocal cord paralysis tioning. Autonomous nodules that do not make sufficient Tamhane and Gharib Clinical Diabetes and Endocrinology (2015) 1:11 Page 3 of 9 thyroid hormone to suppress serum TSH concentrations Indications will appear indeterminate on thyroid scintigraphy. Au- There is increasing evidence that the presence of suspi- tonomous nodules account for only 5 to 10 percent of cious ultrasound features is more predictive of malig- palpable nodules. Only a few patients with autonomous nancy than nodule size alone [8, 9]. Thyroid nodules < nodules have been found to have thyroid cancer [21–23], 1 cm in diameter should not be subjected to FNA, even and only a few of these cancers were aggressive [24]. Since if suspicious. A decision analysis of thyroid nodule bi- hyperfunctioning nodules rarely are cancer, a nodule that opsy criteria for nodules measuring 1.0 to 1.5 cm favors is hyperfunctioning on radioiodine imaging does not re- the approach of selecting nodules with suspicious ultra- quire FNA. sonographic characteristics for biopsy over the approach of biopsy for all nodules ≥1 cm (Table 3) [38]. Indeterminate FNA biopsy is recommended for solid hypoechoic
Load more

Recommended publications
  • Basedow's Bonanza-Graves' Disease
    Journal of Liver Research, Disorders & Therapy Short Communication Open Access The prosperous goitre: basedow’s bonanza-graves’ disease Keywords: graves’ disease, auto-antibodies, thyroid gland, goiter, HLA CD40, CTLA-4, thyroglobulin, TSH receptor, PTPN 22, T cell Volume 4 Issue 3 - 2018 cytokines, toxic goitre, autoimmune hyperthyroidism, oncocytes Anubha Bajaj Abbreviations: TS Ab, thyroid stimulating antibody; TBII, Laboratory AB Diagnostics, India TSH binding inhibitor immunoglobulin; TSB Ab: thyroid stimulation blocking antibody; Anti TPO Ab, anti thyroid peroxidase antibody; Correspondence: Anubha Bajaj, Laboratory A.B. Diagnostics, Anti TG Ab, anti thyroglobulin antibody; TG, thyroglobulin; TSH R, A-1, Ring Road, Rajouri Garden, New Delhi 110027, India, Email [email protected] thyrotropin receptor; HLA, human leucocyte antigen; TRAb, TSH receptor autoantibodies Received: April 6, 2018 | Published: May 11, 2018 Introduction iodide symporter (a protein located in the baso-lateral membrane of An autoimmune disease constituting of hyperthyroidism due the thyrocytes) with an enhanced iodine uptake and a deficiency of to circulating auto-antibodies against thyrotropin (TSH receptor) TSH receptor which mobilizes protein C kinase pathway to control is delineated as Graves Disease.1 An upsurge in thyroid hormone cell proliferation. Pituitary secretion of TSH is restricted with synthesis, secretions and glandular enlargement is elucidated. Aberrant the antagonistic feedback mechanism of the accumulated thyroid glandular stimulation
    [Show full text]
  • Treatment of Radiation-Induced Nodular Goiters
    TREATMENT OF RADIATION-INDUCED NODULAR GOITERS ZsoltG. de Papp,RalphA. Pincusand LouisH. Hempelmann University of Rochester School of Medicine and Dentistry, Rochester, New York Retrospective and prospective epidemiological all patients presented to palpation as solitary or mul studies have shown that prior radiation exposure is tiple nodulesrangingin size from somethat were an important factor in the development of thyroid barely palpable to one massive nodular goiter meas cancer and multinodular goiter in adolescents and uring 6 X 8 X 2 cm. Prior to start of therapy, all young adults (1 ) . In retrospective studies of young patients were examined at least twice by the two persons with thyroid cancer, a history of antecedent senior authors to check on the accuracy and re radiation therapy to the neck or upper chest can producibility of the clinical findings. In each patient usually be elicited by specific questioning (2) . In with a palpably abnormal gland, the serum PB! and prospectivesurveysof selectedpopulationsof young 24-hr 131Juptake were determined, and a “scintiscan― adults with known radiation exposure, the incidence of the gland was carried out. In all but one patient, of neoplasticthyroid diseasecan be remarkably there was no evidence of hypothyroidism. high (1 ) . For example, in the 19 young Marshall In seven patients with nonfunctioning, fixed, stony, Islanders whose thyroid glands were heavily irradi hard or rapidly enlarging nodules, surgery was per ated during childhood by radioactive fission products formed. This was followed by suppressive therapy from a nuclear explosion in 1954, 15 or 78% de with L-thyroxin (0.2 mg daily) for 10 days; then, veloped nodular thyroid disease by 1967 (3) .
    [Show full text]
  • Thyroid Ultrasound
    Review Article Thyroid ultrasound Vikas Chaudhary, Shahina Bano1 Department of Radiodiagnosis, Employees’ State Insurance Corporation Model Hospital, Gurgaon, Haryana, 1Department of Radiodiagnosis, Lady Hardinge Medical College and Associated Smt. Sucheta Kriplani and Kalawati Hospitals, New Delhi, India ABSTRACT Thyroid ultrasonography has established itself as a popular and useful tool in the evaluation and management of thyroid disorders. Advanced ultrasound techniques in thyroid imaging have not only fascinated the radiologists but also attracted the surgeons and endocrinologists who are using these techniques in their daily clinical and operative practice. This review provides an overview of indications for ultrasound in various thyroid diseases, describes characteristic ultrasound findings in these diseases, and illustrates major diagnostic pitfalls of thyroid ultrasound. Key words: Color doppler, high resolution ultrasonography, thyroid, ultrasound, ultrasound elastography INTRODUCTION 1. To confirm presence of a thyroid nodule when physical examination is equivocal. High‑resolution ultrasonography (USG) is the most sensitive 2. To characterize a thyroid nodule(s), i.e. to measure the imaging modality available for examination of the thyroid dimensions accurately and to identify internal structure gland and associated abnormalities. Ultrasound scanning is and vascularization. non‑invasive, widely available, less expensive, and does not use 3. To differentiate between benign and malignant thyroid any ionizing radiation. Further, real time ultrasound imaging masses, based on their sonographic appearance. helps to guide diagnostic and therapeutic interventional 4. To differentiate between thyroid nodules and other procedures in cases of thyroid disease. The major limitation cervical masses like lymphadenopathy, thyroglossal cyst of ultrasound in thyroid imaging is that it cannot determine and cystic hygroma.
    [Show full text]
  • Thyroid Nodules the American Thyroid Association®
    ® This page and its contents are Copyright © 2018 Thyroid Nodules the American Thyroid Association® FAQPage 1 of 2 WHAT IS THE THYROID GLAND? The thyroid gland located in the neck produces thyroid hormones which help the body use energy, stay warm and keep the brain, heart, muscles, and other organs working normally. 1 SYMPTOMS What are the symptoms of a thyroid nodule? The term thyroid nodule refers to any growth of thyroid cells that forms a lump within the thyroid. Most thyroid nodules do not cause any symptoms. Rarely, a nodule can cause pain, difficulty swallowing or breathing, hoarseness, or symptoms of hyperthyroidism. 2 CAUSES What causes a thyroid nodule? Fortunately, 9 out of 10 nodules are benign (noncancerous). These include colloid nodules, follicular neoplasms, and thyroid cysts. Autonomous nodules, which overproduce thyroid hormone, can occasionally lead to hyperthyroidism. We do not know what causes most noncancerous thyroid nodules to grow. Thyroid cancer is the most important cause of a thyroid nodule. Fortunately, cancer occurs in less than 10% of nodules (see Thyroid Cancer brochure). 3 DIAGNOSIS How is a thyroid nodule diagnosed? Most nodules are discovered during an examination of the neck for another reason. Blood tests of thyroid hormone (thyroxine, or T4) and thyroid-stimulating hormone (TSH) are usually normal. Specialized tests are necessary to determine whether a thyroid nodule is cancerous. You may be asked to undergo testing, such as a thyroid ultrasound, thyroid fine needle biopsy, or a thyroid scan. What is a Thyroid ultrasound? Thyroid ultrasound, which uses sound waves to obtain a picture of the thyroid should be used to evaluate thyroid nodules.
    [Show full text]
  • The Thyroid Nodule Clinic INSIDE THIS ISSUE the Challenge Most Thyroid Nodules—About 95%—Are Entirely Points to Remember Benign
    Current Trends in the Practice of Medicine Vol. 27, No. 1, 2011 The Thyroid Nodule Clinic INSIDE THIS ISSUE The Challenge Most thyroid nodules—about 95%—are entirely Points to Remember benign. However, identifying the occasional 2 Perspectives on thyroid cancer requires careful evaluation of every • Thyroid nodules are common, with the Continuing nodule found, using a combination of clinical palpable nodules found in 4% to 7% of Evolution of Therapy assessment, neck palpation, ultrasound imaging the adult US population and solitary or for Atrial Fibrillation (Figure 1), and, in many cases, analysis of a biopsy multiple nodules found at much higher specimen (Figure 2, see page 2). rates during ultrasonographic screening. Sometimes, thyroid nodules are noticed by 4 Advances in Seizure the patient or a family member or are discovered • Early diagnosis improves the likelihood Prevention and Prediction during a routine physical examination. They rarely that a cancer can be discovered while still cause symptoms, unless they are large enough contained within the thyroid gland and to interfere with swallowing. Thyroid cancer can amenable to surgery. 6 Childhood Fractures: invade and damage the recurrent laryngeal nerve, When to Worry causing hoarseness. Such invasion and damage are • Mayo Clinic endocrinologists opened the infrequent, however. Most nodules are incidental Thyroid Nodule Clinic in 2009, providing A discoveries, and now many more such nodules are coordinated care, a thorough assessment, discovered because of the increased use of imaging and a definitive diagnosis completed at a performed for other reasons, including carotid single visit. ultrasonography, neck or chest computed tomog- raphy, magnetic resonance imaging, and even positron emission tomography.
    [Show full text]
  • Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer
    THYROID Volume 16, Number 2, 2006 © American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer The American Thyroid Association Guidelines Taskforce* Members: David S. Cooper,1 (Chair), Gerard M. Doherty,2 Bryan R. Haugen,3 Richard T. Kloos,4 Stephanie L. Lee,5 Susan J. Mandel,6 Ernest L. Mazzaferri,7 Bryan McIver,8 Steven I. Sherman,9 and R. Michael Tuttle10 Contents 1. Introduction . 4 2. Methods . 4 a. Literature search strategy b. Evaluation of the evidence 3. Thyroid Nodules . 5 a. Thyroid nodule evaluation iii. Laboratory studies iii. Fine needle aspiration biopsy iii. Multinodular goiter b. Thyroid nodule follow up and treatment ii. Long-term follow-up iii. Role of medical therapy iii. Thyroid nodules and pregnancy 4. Differentiated Thyroid Cancer . 8 a. Goals of therapy b. Role of preoperative staging with diagnostic testing c. Surgery for differentiated thyroid cancer iii. Extent of initial surgery iii. Completion thyroidectomy d. Pathological and clinical staging systems e. Postoperative radioiodine remnant ablation iii. Modes of thyroid hormone withdrawal iii. Role of diagnostic scanning before ablation iii. Radioiodine ablation dosage iv. Use of recombinant human thyrotropin for remnant ablation iv. Role of low iodine diets vi. Performance of post therapy scans f. Thyroxine suppression therapy g. Role of adjunctive external beam radiation or chemotherapy 5. Differentiated Thyroid Cancer: Long-Term Management . 13 a. Risk stratification for follow-up intensity b. Utility of serum thyroglobulin measurements c. Role of diagnostic radioiodine scans, ultrasound, and other imaging techniques d. Long-term thyroxine suppression therapy e. Management of patients with metastatic disease iii.
    [Show full text]
  • Thyroid Nodules Are Extremely Common in the General Population
    2. THE PATHOLOGY OF THYROID CANCER SYLVIA L. ASA Professor, Department of Laboratory Medicine & Pathobiology, University of Toronto; Pathologist-in-Chief, University Health Network and Toronto Medical Laboratories; Freeman Centre for Endocrine Oncology, Mount Sinai & Princess Margaret Hospitals; Toronto, Ontario Canada Thyroid nodules are extremely common in the general population; it has been esti- mated that about 20% of the population has a palpable thyroid nodule and approxi- mately 70% has a nodule that can be detected by ultrasound (1). The prevalence of thyroid nodules is greater in women than in men, and multiple nodules are more common than solitary nodules. The differential diagnosis of the thyroid nodule includes numerous entities, non-neoplastic and neoplastic, benign and malignant (2–5). The pathologist has an important role to play in their evaluation. The use of fine needle aspiration biopsy has significantly improved our ability to identify specific high-risk disorders and to facilitate their management in an expeditious and cost-effective manner. Patients who require surgery for further confirmation of the disease process rely upon the pathologist to correctly characterise their nodule and pathologists are actively involved in research to clarify the pathogenesis of thyroid disease. While some of these entities are readily diagnosed based on specific features seen in a routine slide stained with conventional dyes, the morphologic evaluation of many of these lesions is fraught with controversy and diagnostic criteria are highly variable from Pathologist to Pathologist (6). Nevertheless, histology remains the gold standard against which we measure outcomes of cytology, intraoperative consultations, molecular and other studies, and it represents the basis on which we determine patient management and the efficacy of various therapies.
    [Show full text]
  • Management of Graves Disease:€€A Review
    Clinical Review & Education Review Management of Graves Disease A Review Henry B. Burch, MD; David S. Cooper, MD Author Audio Interview at IMPORTANCE Graves disease is the most common cause of persistent hyperthyroidism in adults. jama.com Approximately 3% of women and 0.5% of men will develop Graves disease during their lifetime. Supplemental content at jama.com OBSERVATIONS We searched PubMed and the Cochrane database for English-language studies CME Quiz at published from June 2000 through October 5, 2015. Thirteen randomized clinical trials, 5 sys- jamanetworkcme.com and tematic reviews and meta-analyses, and 52 observational studies were included in this review. CME Questions page 2559 Patients with Graves disease may be treated with antithyroid drugs, radioactive iodine (RAI), or surgery (near-total thyroidectomy). The optimal approach depends on patient preference, geog- raphy, and clinical factors. A 12- to 18-month course of antithyroid drugs may lead to a remission in approximately 50% of patients but can cause potentially significant (albeit rare) adverse reac- tions, including agranulocytosis and hepatotoxicity. Adverse reactions typically occur within the first 90 days of therapy. Treating Graves disease with RAI and surgery result in gland destruction or removal, necessitating life-long levothyroxine replacement. Use of RAI has also been associ- ated with the development or worsening of thyroid eye disease in approximately 15% to 20% of patients. Surgery is favored in patients with concomitant suspicious or malignant thyroid nodules, coexisting hyperparathyroidism, and in patients with large goiters or moderate to severe thyroid Author Affiliations: Endocrinology eye disease who cannot be treated using antithyroid drugs.
    [Show full text]
  • Treating Thyroid Disease: a Natural Approach to Healing Hashimoto's
    Treating Thyroid Disease: A Natural Approach to Healing Hashimoto’s Melissa Lea-Foster Rietz, FNP-BC, BC-ADM, RYT-200 Presbyterian Medical Services Farmington, NM [email protected] Professional Disclosures I have no personal or professional affiliation with any of the resources listed in this presentation, and will receive no monetary gain or professional advancement from this lecture. Talk Objectives • Define hypothyroidism and Hashimoto’s. • Discuss various tests used to identify thyroid disease and when to treat based on patient symptoms • Discuss potential causes and identify environmental factors that contribute to disease • Describe how the gut (food sensitivities) and the adrenals (chronic stress) are connected to Hashimoto’s and how we as practitioners can work to educate patients on prevention before the need for treatment • How the use of adaptogens can enhance the treatment of Hashimoto’s and identify herbs that are showing promise in the research. • How to use food, exercise, and relaxation to improve patient outcomes. Named for Hakuro Hashimoto, a physician working in Europe in the early 1900’s. Hashimoto’s was the first autoimmune disease to be recognized in the scientific literature. It is estimated that one in five people suffer from an autoimmune disease and the numbers continue to rise. Women are more likely than men to develop an autoimmune disease, and it is believed that 75% of individuals with an autoimmune disease are female. Thyroid autoimmune disease is the most common form, and affects 7-8% of the population in the United States. Case Study Ms. R is a 30-year-old female, mother of three, who states that after the birth of her last child two years ago she has felt the following: • Loss of energy • Difficulty losing weight despite habitual eating pattern • Hair loss • Irregular menses • Joints that ache throughout the day • A general sense of sadness • Cold Intolerance • Joint and Muscle Pain • Constipation • Irregular menstruation • Slowed Heart Rate What tests would you run on Ms.
    [Show full text]
  • The Thyroid Nodule Information for Patients
    The Thyroid Nodule Information for Patients What is a thyroid nodule? operations, since fewer than 10% of the removed nodules proved to be cancer. Most removed The thyroid gland is located in the lower front nodules could have simply been observed or of the neck, below the larynx (“Adam’s apple”) treated medically. and above the collarbones. A thyroid nodule is a lump in or on the thyroid gland. Thyroid nodules It is not usually possible for a physician to are common and occur in about 4% of women determine whether a thyroid nodule is cancerous and 1% of men; they are less common in on the basis of a physical examination or younger patients and increase in frequency with blood tests. Endocrin ologists rely heavily on age. Sometimes several nodules will develop in 3 specialized tests for help in deciding which the same person. Any time a lump is discovered nodules should be treated surgically: in thyroid tissue, the possibility of malignancy (cancer) must be considered. Fortunately, the tThyroid fine needle biopsy vast majority of thyroid nodules are benign (not tThyroid scan cancerous). tThyroid ultrasonography Many patients with thyroid nodules have no symptoms whatsoever, and are found by What is a thyroid needle biopsy? chance to have a lump in the thyroid gland on a routine physical exam or an imaging study of A thyroid fine needle biopsy is a simple the neck done for unrelated reasons (CT or MRI pro ce dure that can be performed in the scan of spine or chest, carotid ultrasound, etc). physician’s office.
    [Show full text]
  • Feline Hyperthyroidism
    Feline Hyperthyroidism Sponsored by Feline Hyperthyroidism Feline hyperthyroidism is the most common endocrine disorder in middle-aged to left) are advanced. Blood testing and older cats. It occurs in about 10 percent of feline patients over 10 years of age. can reveal elevation of thyroid Hyperthyroidism is a disease caused by an overactive thyroid gland that secretes hormones to establish a diagnosis excess thyroid hormone. Cats typically have two thyroid glands, one gland on of hyperthyroidism. Occasionally, each side of the neck. One or both glands may be affected. The excess thyroid additional diagnostics may be hormone causes an overactive metabolism that stresses the heart, digestive tract, required to confirm the diagnosis. and many other organ systems. Because hyperthyroidism can occur along with other medical conditions, If your veterinarian diagnoses your cat with hyperthyroidism, your cat should and it affects other organs, a receive some form of treatment to control the clinical signs. Many cats that are comprehensive screening of your diagnosed early can be treated successfully. When hyperthyroidism goes untreated, Cat years prior to developing the disease Same cat with hyperthyroidism cat’s heart, kidneys, and other clinical signs will progress leading to marked weight loss and serious complications organ systems is imperative. due to damage to the cat’s heart, kidneys, and other organ systems. MANAGEMENT AND TREATMENT OPTIONS CLINICAL SIGNS If your veterinarian diagnoses your cat with hyperthyroidism, he or she will discuss If you observe any of the following behaviors or problems in your cat, contact and recommend treatment options for your cat. Four common treatments for feline your veterinarian because the information may alert them to the possibility that hyperthyroidism are available and each has advantages and disadvantages.
    [Show full text]
  • Heterogenous Morphologic Forms of Goiter in Autoimmune Thyroid Disease
    WJOES Heterogenous Morphologic Forms of Goiter in Autoimmune Thyroid Disease: An Insight based10.5005/jp-journals-10002-1140 on a Prospective Surgical Series ORIGINAL ARTICLE Heterogenous Morphologic Forms of Goiter in Autoimmune Thyroid Disease: An Insight based on a Prospective Surgical Series of 88 Cases PRK Bhargav ABSTRACT Usually, both GD and HT have diffuse goiter due to bilateral Two commonest forms of autoimmune thyroid disease (AITD) symmetrical involvement of thyroid gland by the disease are Graves’ disease (GD) and Hashimoto’s thyroiditis (HT) with process.7 But, in 20 to 30% of cases, they may be associated a diffuse goiter. The nature of goiter apart from clinical presenta- with nodules or assymetrical enlargement.8-11 The variability tion is crucial in the management of AITD. But, the goiter is not always diffuse, leading to diagnostic confusion. In this context, in proportion of nodularity depends upon clinical or sono- we conducted a prospective study on the goiter morphology in graphic methods of evaluation. In a classical case of AITD AITD. This is a prospective study conducted in Endocrine Surgery department of a teritiary care teaching hospital in South India (i.e. with usual clinical presentation, cardinal signs and over a period of 1 year. The cohort is a surgical series of 88 cases diffuse goiter), the standard diagnostic protocol with imaging of AITD (GD = 53; HT = 35). Morpho logy of all the ex vivo speci- and serology suffices, but appears to be insufficient in AITD mens were studied, documented and correlated with clinical and radiological forms of goiter. Sex ratio was M:F = 74:14.
    [Show full text]