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== Overview == | == Overview == | ||
There is no definite diagnostic criteria for thyroid nodule. Different diagnostic methods can be used to diagnose thyroid nodules, based on their specific properties. [[Thyroid function test|Thyroid function]] should be assessed in all patients with thyroid nodules as the primary diagnostic step in all patients with a [[Neck masses|neck mass]]. The primary evaluation method that should be used in the thyroid nodule evaluation is thyroid [[ultrasound]]. [[Cytology]] differentiates between [[malignant]] and [[benign]] lesions. After a suspicion of thyroid malignancy based on [[ultrasound]] features, [[Needle aspiration biopsy|fine needle aspiration biopsy]] (FNAB) is the most appropriate method for further evaluation. [[Scintigraphy|Thyroid scintigraphy]] is used to determine the functional status of a nodule. [[Scintigraphy]] utilizes one of the [[radioisotopes]] of [[iodine]] (usually [[I-123 thyroid imaging|I-123]]) or [[Pertechnetate|technetium-99m pertechnetate]]. | |||
== Diagnostic | == Diagnostic Criteria == | ||
*Thyroid function should be assessed in all patients with thyroid nodules. | * There is no definite diagnostic criteria for thyroid nodule. Different diagnostic methods can be used to diagnose thyroid nodules, based on their specific properties. | ||
*Thyroid ultrasound should be performed in all patients with a suspected thyroid nodule or nodular goiter on physical examination or with nodules incidentally noted on other imaging studies | * [[Thyroid function test|Thyroid function tests]] should be assessed in all patients with thyroid nodules as the primary diagnostic step in all patients with a [[Neck masses|neck mass]]. | ||
* The primary evaluation method that should be used in the thyroid nodule evaluation is [[thyroid]] [[ultrasound]]. [[Thyroid]] [[ultrasound]] should be performed in all patients with a suspected [[thyroid]] nodule or [[Goiter|nodular goiter]] on [[physical examination]] or with nodules incidentally noted on other imaging studies. [[Ultrasound]] diagnosis of [[malignant]] thyroid nodules if done based on marked hypoechogenicity, [[microcalcification]] and mixed central, peripheral or central [[Doppler ultrasonography|doppler color flow]] pattern has [[sensitivity]] of 100 % and a [[specificity]] of 76 % were obtained in detecting [[malignant]] nodules using this criteria:<ref name="pmid23712566">{{cite journal |vauthors=Lingam RK, Qarib MH, Tolley NS |title=Evaluating thyroid nodules: predicting and selecting malignant nodules for fine-needle aspiration (FNA) cytology |journal=Insights Imaging |volume=4 |issue=5 |pages=617–24 |year=2013 |pmid=23712566 |pmc=3781256 |doi=10.1007/s13244-013-0256-6 |url=}}</ref> | |||
**[[Ultrasound]] indication critera: | |||
*** Suspected thyroid nodule | |||
*** [[Goiter|Nodular goiter]] | |||
*** [[Radiographic]] abnormality | |||
==== | **** Nodule found incidentally on [[Computed tomography|computed tomography (CT)]] or [[Magnetic resonance imaging|magnetic resonance imaging (MRI)]] | ||
* Suspected thyroid nodule | **** Thyroidal uptake on 18FDG-[[PET scan]] | ||
* Nodular goiter | *Subsequent evaluation is based upon the [[TSH]] level and sonographic features of the nodules. | ||
* Radiographic abnormality | *[[Cytology]] differentiates between [[benign]] and [[malignant]] lesions. [[Cytology]] is the primary determinant in thyroid nodule management. After a suspicion of thyroid [[malignancy]] based on [[ultrasound]] features, [[Fine needle aspiration|fine needle aspiration biopsy]] (FNAB) is the most appropriate method for further evaluation. Overall [[sensitivity]] and [[specificity]] of the FNAB technique have been reported to be 83% and 92% respectively.<ref name="pmid22948464">{{cite journal |vauthors=Maia FF, Zantut-Wittmann DE |title=Thyroid nodule management: clinical, ultrasound and cytopathological parameters for predicting malignancy |journal=Clinics (Sao Paulo) |volume=67 |issue=8 |pages=945–54 |year=2012 |pmid=22948464 |pmc=3416902 |doi= |url=}}</ref> | ||
** Nodule found incidentally on computed tomography (CT) or magnetic resonance imaging (MRI) | |||
** Thyroidal uptake on 18FDG-PET scan | |||
</ | |||
*[[Scintigraphy|Thyroid scintigraphy]] is used to determine the functional status of a nodule. [[Scintigraphy]] utilizes one of the [[radioisotopes]] of [[iodine]] (usually [[I-123 thyroid imaging|I-123]]) or [[Technetium-99m|technetium-99m pertechnetate]]. If available, [[radioiodine]] scanning is preferred. Studies suggest that with an uptake threshold of 15.2%, [[sensitivity]] and [[specificity]] of [[Scintigraphy|thyroid scinitigraphy]] are 82.4% and 69.0% respectively.<ref name="pmid25879041">{{cite journal |vauthors=Hou H, Hu S, Fan R, Sun W, Zhang X, Tian M |title=Prognostic value of (99m)Tc-pertechnetate thyroid scintigraphy in radioiodine therapy in a cohort of Chinese Graves' disease patients: a pilot clinical study |journal=Biomed Res Int |volume=2015 |issue= |pages=974689 |year=2015 |pmid=25879041 |pmc=4387899 |doi=10.1155/2015/974689 |url=}}</ref> | |||
=== Diagnostic approach === | |||
The following approach is based on American Thyroid Association (ATA) guidelines for assessment of thyroid nodules, the latest version was released in 2015.<ref name="urlATA Professional Guidelines | American Thyroid Association">{{cite web |url=https://www.thyroid.org/professionals/ata-professional-guidelines/ |title=ATA Professional Guidelines | American Thyroid Association |format= |work= |accessdate=}}</ref> | |||
{| align="center" | {| align="center" | ||
|- | |- | ||
| | | | ||
{{familytree/start |summary=Thyroid Nodule Evaluation Algorithm}} | {{familytree/start |summary=Thyroid Nodule Evaluation Algorithm}} | ||
{{familytree | {{familytree | | | | | | | | | | | A01 | | | | | | | | | | | | | A01= '''Thyroid nodule found clinically or incidentally'''}} | ||
{{familytree | {{familytree | | | | | | | | | | | |!| | | | | | | | | | | | |}} | ||
{{familytree | {{familytree | | | | | | | | | | | B01 | | | | | | | | | | | | | B01=''' TSH '''}} | ||
{{familytree | | | | | | | | | | | | | | | | | | | | | {{familytree | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | |}} | ||
{{familytree | {{familytree | |,|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|.| | | }} | ||
{{familytree | {{familytree | C01 | | | | | | | | | | | | | | | | | | C02 | C01 = '''Normal or elevated''' | C02 = '''Subnormal'''}} | ||
{{familytree | | | {{familytree | |!| | | | | | | | | | | | | | | | | | | |!| | | | | |}} | ||
{{familytree | {{familytree | |!| | | | | | | | | | | | | | | | | | | C01 | | | | | | C01 = '''Radionuclide thyroid scan'''}} | ||
{{familytree | {{familytree | |!| | | | | | | | | | | | | | |,|-|-|-|-|^|-|-|-|-|.| |}} | ||
{{familytree | | | | | | | | | | | {{familytree | |!| | | | | | | | | | | | | | C01 | | | | | | | | C02 | | | C01 = Nodule not up taking the radionuclide <br>'''Cold nodule''' <br> Nodule is non-functional | C02 = Nodule up taking the radionuclide '''Hot nodule''' <br> Nodule is functional}} | ||
{{familytree | {{familytree | |!| | | | | | | | | | | | | | |!| | | | | | | | | |!| | | | }} | ||
{{familytree | {{familytree | |`|-|-|-|-|-|-|-|-|-|-|-|-|-| C01 | | | | | | | | C02 | | | | C01 = Ultrasound evaluation | C02 = Check thyroid hormones <br> '''Free T4 and T3 check'''}} | ||
{{familytree | | | | | | | | | | | | | | | | | | {{familytree | | | | | | | | | | | | | | | | |!| | | | | | | | | |!| }} | ||
{{familytree | {{familytree | | | | | | | | | | |,|-|-|-|-|-|^|-|.| | | | | |,|-|^|-|.| }} | ||
{{familytree | {{familytree | | | | | | | | | | C01 | | | | | | C02 | | | | C03 | | C04 | C01 = Meets the criteria <br> | C02 = Does not meet criteria | C03 = Normal <br> '''Subclinical hypothyroidism''' | C04 = Elevated <br> '''Thyroid adenoma''' <br> ''' Hyperthyroidism'''}} | ||
{{familytree | | | | | | | | | | | | {{familytree | | | | | | | | | | |!| | | | | | | |!| | | | | |!| | | | | | | }} | ||
{{familytree | {{familytree | | | | | | | | | | C01 | | | | | | |`|-|-|v|-|-|'| | | | | | C01 = '''FNA''' | }} | ||
{{familytree | | | | | | | | | | | | | | | | | | | | | A01 | | | | | A01 = Management of the underlying disease <br> Rule out other differential diagnosis }} | |||
{{familytree/end}} | {{familytree/end}} | ||
|} | |} | ||
<span style="font-size:85%">'''Abbreviations:''' | |||
'''TSH:''' [[Thyroid stimulating hormone]], '''FNA:''' [[FNA|Fine needle aspiration]], '''FLUS:''' Follicular lesion of undetermined significance, '''AUS:''' Atypia of undetermined significance.</span><br> | |||
== References == | == References == | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 16:29, 6 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]
Overview
There is no definite diagnostic criteria for thyroid nodule. Different diagnostic methods can be used to diagnose thyroid nodules, based on their specific properties. Thyroid function should be assessed in all patients with thyroid nodules as the primary diagnostic step in all patients with a neck mass. The primary evaluation method that should be used in the thyroid nodule evaluation is thyroid ultrasound. Cytology differentiates between malignant and benign lesions. After a suspicion of thyroid malignancy based on ultrasound features, fine needle aspiration biopsy (FNAB) is the most appropriate method for further evaluation. Thyroid scintigraphy is used to determine the functional status of a nodule. Scintigraphy utilizes one of the radioisotopes of iodine (usually I-123) or technetium-99m pertechnetate.
Diagnostic Criteria
- There is no definite diagnostic criteria for thyroid nodule. Different diagnostic methods can be used to diagnose thyroid nodules, based on their specific properties.
- Thyroid function tests should be assessed in all patients with thyroid nodules as the primary diagnostic step in all patients with a neck mass.
- The primary evaluation method that should be used in the thyroid nodule evaluation is thyroid ultrasound. Thyroid ultrasound should be performed in all patients with a suspected thyroid nodule or nodular goiter on physical examination or with nodules incidentally noted on other imaging studies. Ultrasound diagnosis of malignant thyroid nodules if done based on marked hypoechogenicity, microcalcification and mixed central, peripheral or central doppler color flow pattern has sensitivity of 100 % and a specificity of 76 % were obtained in detecting malignant nodules using this criteria:[1]
- Ultrasound indication critera:
- Suspected thyroid nodule
- Nodular goiter
- Radiographic abnormality
- Nodule found incidentally on computed tomography (CT) or magnetic resonance imaging (MRI)
- Thyroidal uptake on 18FDG-PET scan
- Ultrasound indication critera:
- Subsequent evaluation is based upon the TSH level and sonographic features of the nodules.
- Cytology differentiates between benign and malignant lesions. Cytology is the primary determinant in thyroid nodule management. After a suspicion of thyroid malignancy based on ultrasound features, fine needle aspiration biopsy (FNAB) is the most appropriate method for further evaluation. Overall sensitivity and specificity of the FNAB technique have been reported to be 83% and 92% respectively.[2]
- Thyroid scintigraphy is used to determine the functional status of a nodule. Scintigraphy utilizes one of the radioisotopes of iodine (usually I-123) or technetium-99m pertechnetate. If available, radioiodine scanning is preferred. Studies suggest that with an uptake threshold of 15.2%, sensitivity and specificity of thyroid scinitigraphy are 82.4% and 69.0% respectively.[3]
Diagnostic approach
The following approach is based on American Thyroid Association (ATA) guidelines for assessment of thyroid nodules, the latest version was released in 2015.[4]
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Abbreviations:
TSH: Thyroid stimulating hormone, FNA: Fine needle aspiration, FLUS: Follicular lesion of undetermined significance, AUS: Atypia of undetermined significance.
References
- ↑ Lingam RK, Qarib MH, Tolley NS (2013). "Evaluating thyroid nodules: predicting and selecting malignant nodules for fine-needle aspiration (FNA) cytology". Insights Imaging. 4 (5): 617–24. doi:10.1007/s13244-013-0256-6. PMC 3781256. PMID 23712566.
- ↑ Maia FF, Zantut-Wittmann DE (2012). "Thyroid nodule management: clinical, ultrasound and cytopathological parameters for predicting malignancy". Clinics (Sao Paulo). 67 (8): 945–54. PMC 3416902. PMID 22948464.
- ↑ Hou H, Hu S, Fan R, Sun W, Zhang X, Tian M (2015). "Prognostic value of (99m)Tc-pertechnetate thyroid scintigraphy in radioiodine therapy in a cohort of Chinese Graves' disease patients: a pilot clinical study". Biomed Res Int. 2015: 974689. doi:10.1155/2015/974689. PMC 4387899. PMID 25879041.
- ↑ "ATA Professional Guidelines | American Thyroid Association".