Thyroid nodule history and symptoms: Difference between revisions
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==Overview== | ==Overview== | ||
The most important aspects in obtaining a history | The most important aspects in obtaining a history of a patient presenting with thyroid nodule include, looking for the presence of associated [[symptoms]], change in nodule size, previous head or neck radiation exposure, childhood [[irradiation]] associated with high risk of [[malignancy]], [[family history]], history of [[neck pain]], sudden increase in the size of a neck lump, and progressive voice change or [[hoarseness]]. The [[symptoms]] associated to thyroid nodule include, [[dysphagia]] or anterior [[neck]] discomfort, [[hoarseness]], localized pain in the neck, [[shortness of breath]], and prolonged [[cough]]. | ||
==History and Symptoms== | ==History and Symptoms== | ||
=== History === | === History === | ||
Obtaining a detailed history is one of the important aspects of determining the best approach | Obtaining a detailed history is one of the important aspects of determining the best approach towards nodule management. It provides insight into possible cause, precipitating factors and associated [[Comorbidity|comorbid]] conditions. Complete history may also helps in determining the [[prognosis]]. Specific histories about associated [[symptoms]] and their duration, onset, and progression have to be obtained. Specific areas of focus when obtaining the history, are outlined below:<ref name="pmid22443979">{{cite journal |vauthors=Popoveniuc G, Jonklaas J |title=Thyroid nodules |journal=Med. Clin. North Am. |volume=96 |issue=2 |pages=329–49 |year=2012 |pmid=22443979 |pmc=3575959 |doi=10.1016/j.mcna.2012.02.002 |url=}}</ref><ref name="pmid21460787">{{cite journal |vauthors=Milas Z, Shin J, Milas M |title=New guidelines for the management of thyroid nodules and differentiated thyroid cancer |journal=Minerva Endocrinol. |volume=36 |issue=1 |pages=53–70 |year=2011 |pmid=21460787 |doi= |url=}}</ref><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> | ||
* The presence of associated symptoms | * The presence of associated [[symptoms]] | ||
* A change in nodule size | * A change in nodule size | ||
* Previous head or neck radiation exposure | * Previous head or neck [[Radiation therapy|radiation]] exposure | ||
** Childhood [[irradiation]] associated with high risk of [[malignancy]] | ** Childhood [[irradiation]] associated with high risk of [[malignancy]] | ||
* [[Family history]] | * [[Family history]] | ||
| Line 29: | Line 19: | ||
** [[Endocrine diseases]] (e.g. [[MEN, type 2|multiple endocrine neoplasia type 2 [MEN2]]], [[familial adenomatous polyposis]], or [[Cowden syndrome]]) | ** [[Endocrine diseases]] (e.g. [[MEN, type 2|multiple endocrine neoplasia type 2 [MEN2]]], [[familial adenomatous polyposis]], or [[Cowden syndrome]]) | ||
* History of [[neck pain]] | * History of [[neck pain]] | ||
* Sudden increase in the size of a neck lump | * Sudden increase in the size of a [[neck]] lump | ||
** Raise the concern of [[malignancies]] and hemorrhagic thyroid cysts | ** Raise the concern of [[malignancies]] and [[hemorrhagic]] [[thyroid]] cysts | ||
* Progressive voice change or [[hoarseness]] | * Progressive voice change or [[hoarseness]] | ||
** May be associated with an [[Thyroid cancer|invasive thyroid carcinoma]] | ** May be associated with an [[Thyroid cancer|invasive thyroid carcinoma]] | ||
=== Common symptoms <ref name="pmid20510711">{{cite journal |vauthors=Bomeli SR, LeBeau SO, Ferris RL |title=Evaluation of a thyroid nodule |journal=Otolaryngol. Clin. North Am. |volume=43 |issue=2 |pages=229–38, vii |year=2010 |pmid=20510711 |pmc=2879398 |doi=10.1016/j.otc.2010.01.002 |url=}}</ref><ref name="pmid12115799">{{cite journal |vauthors=Lawrence W, Kaplan BJ |title=Diagnosis and management of patients with thyroid nodules |journal=J Surg Oncol |volume=80 |issue=3 |pages=157–70 |year=2002 |pmid=12115799 |doi=10.1002/jso.10115 |url=}}</ref><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><ref name="pmid25964831">{{cite journal |vauthors=Nguyen QT, Lee EJ, Huang MG, Park YI, Khullar A, Plodkowski RA |title=Diagnosis and treatment of patients with thyroid cancer |journal=Am Health Drug Benefits |volume=8 |issue=1 |pages=30–40 |year=2015 |pmid=25964831 |pmc=4415174 |doi= |url=}}</ref> === | |||
=== Common | * [[Dysphagia]] or anterior [[neck]] discomfort | ||
<ref name="pmid12115799">{{cite journal |vauthors=Lawrence W, Kaplan BJ |title=Diagnosis and management of patients with thyroid nodules |journal=J Surg Oncol |volume=80 |issue=3 |pages=157–70 |year=2002 |pmid=12115799 |doi=10.1002/jso.10115 |url=}}</ref> <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><ref name="pmid25964831">{{cite journal |vauthors=Nguyen QT, Lee EJ, Huang MG, Park YI, Khullar A, Plodkowski RA |title=Diagnosis and treatment of patients with thyroid cancer |journal=Am Health Drug Benefits |volume=8 |issue=1 |pages=30–40 |year=2015 |pmid=25964831 |pmc=4415174 |doi= |url=}}</ref>=== | |||
* [[Dysphagia]] or anterior neck discomfort | |||
** May indicate a [[malignant tumor]] | ** May indicate a [[malignant tumor]] | ||
** Rarely seen in [[benign tumors]] | ** Rarely seen in [[benign tumors]] | ||
| Line 44: | Line 31: | ||
** Inability to lie flat | ** Inability to lie flat | ||
* [[Hoarseness]] | * [[Hoarseness]] | ||
* Localized pain in the neck | * Localized pain in the [[neck]] | ||
* [[Shortness of breath]] | * [[Shortness of breath]] | ||
* Prolonged [[cough]] | * Prolonged [[cough]] | ||
=== Less | === Less common symptoms === | ||
These are mainly due to hot nodules producing hormones:<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><ref name="pmid25964831">{{cite journal |vauthors=Nguyen QT, Lee EJ, Huang MG, Park YI, Khullar A, Plodkowski RA |title=Diagnosis and treatment of patients with thyroid cancer |journal=Am Health Drug Benefits |volume=8 |issue=1 |pages=30–40 |year=2015 |pmid=25964831 |pmc=4415174 |doi= |url=}}</ref> | These are mainly due to hot nodules producing [[hormones]]:<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><ref name="pmid25964831">{{cite journal |vauthors=Nguyen QT, Lee EJ, Huang MG, Park YI, Khullar A, Plodkowski RA |title=Diagnosis and treatment of patients with thyroid cancer |journal=Am Health Drug Benefits |volume=8 |issue=1 |pages=30–40 |year=2015 |pmid=25964831 |pmc=4415174 |doi= |url=}}</ref> | ||
* [[Palpitation]] | * [[Palpitation]] | ||
Latest revision as of 18:49, 25 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The most important aspects in obtaining a history of a patient presenting with thyroid nodule include, looking for the presence of associated symptoms, change in nodule size, previous head or neck radiation exposure, childhood irradiation associated with high risk of malignancy, family history, history of neck pain, sudden increase in the size of a neck lump, and progressive voice change or hoarseness. The symptoms associated to thyroid nodule include, dysphagia or anterior neck discomfort, hoarseness, localized pain in the neck, shortness of breath, and prolonged cough.
History and Symptoms
History
Obtaining a detailed history is one of the important aspects of determining the best approach towards nodule management. It provides insight into possible cause, precipitating factors and associated comorbid conditions. Complete history may also helps in determining the prognosis. Specific histories about associated symptoms and their duration, onset, and progression have to be obtained. Specific areas of focus when obtaining the history, are outlined below:[1][2][3]
- The presence of associated symptoms
- A change in nodule size
- Previous head or neck radiation exposure
- Childhood irradiation associated with high risk of malignancy
- Family history
- History of neck pain
- Sudden increase in the size of a neck lump
- Raise the concern of malignancies and hemorrhagic thyroid cysts
- Progressive voice change or hoarseness
- May be associated with an invasive thyroid carcinoma
Common symptoms [4][5][3][6]
- Dysphagia or anterior neck discomfort
- May indicate a malignant tumor
- Rarely seen in benign tumors
- Choking sensation
- Inability to lie flat
- Hoarseness
- Localized pain in the neck
- Shortness of breath
- Prolonged cough
Less common symptoms
These are mainly due to hot nodules producing hormones:[3][6]
- Palpitation
- Heat intolerance
- Weight loss
- Night sweats
References
- ↑ Popoveniuc G, Jonklaas J (2012). "Thyroid nodules". Med. Clin. North Am. 96 (2): 329–49. doi:10.1016/j.mcna.2012.02.002. PMC 3575959. PMID 22443979.
- ↑ Milas Z, Shin J, Milas M (2011). "New guidelines for the management of thyroid nodules and differentiated thyroid cancer". Minerva Endocrinol. 36 (1): 53–70. PMID 21460787.
- ↑ 3.0 3.1 3.2 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.
- ↑ Bomeli SR, LeBeau SO, Ferris RL (2010). "Evaluation of a thyroid nodule". Otolaryngol. Clin. North Am. 43 (2): 229–38, vii. doi:10.1016/j.otc.2010.01.002. PMC 2879398. PMID 20510711.
- ↑ Lawrence W, Kaplan BJ (2002). "Diagnosis and management of patients with thyroid nodules". J Surg Oncol. 80 (3): 157–70. doi:10.1002/jso.10115. PMID 12115799.
- ↑ 6.0 6.1 Nguyen QT, Lee EJ, Huang MG, Park YI, Khullar A, Plodkowski RA (2015). "Diagnosis and treatment of patients with thyroid cancer". Am Health Drug Benefits. 8 (1): 30–40. PMC 4415174. PMID 25964831.