Thyroid nodule diagnostic study of choice: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
|||
Line 6: | Line 6: | ||
== Diagnostic criteria == | == Diagnostic criteria == | ||
*Thyroid function should be assessed in all patients with thyroid nodules. | |||
*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 | |||
*Subsequent evaluation is based upon the TSH level and sonographic features of the nodule(s) | |||
*Thyroid scintigraphy is used to determine the functional status of a nodule. | |||
*Scintigraphy utilizes one of the radioisotopes of iodine (usually 123-I) or technetium-99m pertechnetate. If available, radioiodine scanning is preferred. | |||
* | |||
==== Ultrasound indicating critera ==== | ==== Ultrasound indicating critera ==== | ||
Line 13: | Line 19: | ||
** Nodule found incidentally on computed tomography (CT) or magnetic resonance imaging (MRI) | ** Nodule found incidentally on computed tomography (CT) or magnetic resonance imaging (MRI) | ||
** Thyroidal uptake on 18FDG-PET scan | ** Thyroidal uptake on 18FDG-PET scan | ||
== Diagnostic approach == | |||
== FIRE == | |||
<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> | |||
<small> | |||
{| align="center" | |||
|- | |||
| | |||
{{familytree/start |summary=Thyroid Nodule Evaluation Algorithm}} | |||
{{familytree | | | | | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | A01= '''Thyroid nodule found clinically or incidentally'''}} | |||
{{familytree | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | |}} | |||
{{familytree | | | | | | | | | | | | | | | | | | | B01 | | | | | | | | | | | | | B01=''' TSH '''}} | |||
{{familytree | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | |}} | |||
{{familytree | | | | | | | | | |,|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|.| | | }} | |||
{{familytree | | | | | | | | | C01 | | | | | | | | | | | | | | | | | | C02 | C01 = '''Normal or elevated''' | C02 = '''Subnormal'''}} | |||
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | |!| | | | | |}} | |||
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | C01 | | | | | | C01 = '''Radionuclide thyroid scan'''}} | |||
{{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 | | | | | | | | | |`|-|-|-|-|-|-|-|-|-|-|-|-|-| C01 | | | | | | | | C02 | | | | C01 = Ultrasound evaluation | C02 = Check thyroid hormones<br> '''Free T4 and T3 check'''}} | |||
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | |!| }} | |||
{{familytree | | | | | | | | | | | | | | | | | | |,|-|-|-|-|-|^|-|.| | | | | |,|-|^|-|.| }} | |||
{{familytree | | | | | | | | | | | | | | | | | | C01 | | | | | | C02 | | | | C03 | | C04 | C01 = Meets the criteria <br> | C02 = Doesn't meet criteria | C03 = Normal <br> '''Subclinical hypothyroidism''' | C04 = Elevated <br> '''Thyroid adenoma''' <br> ''' Hyperthyroidism'''}} | |||
{{familytree | | | | | | | | | | | | | | | | | | |!| | | | | | | |!| | | | | |!| | | |!| | | }} | |||
{{familytree | | | | | | | | | | | | | | | | | | C01 | | | | | | |`|-|-|v|-|-|'| | | C02 | | C01 = '''FNA''' | C02 = '''Treat hyperthyroidism'''}} | |||
{{familytree | | | | | | | | | | | | | | | | | | |!| | | | | | | | | | C04 | | | | | | | | | C04 = '''Monitoring'''}} | |||
{{familytree | | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | }} | |||
{{familytree | | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | }} | |||
{{familytree | | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | }} | |||
{{familytree | | | |,|-|-|-|-|-|-|-|-|-|v|-|-|-|-|+|-|-|-|-|v|-|-|-|-|v|-|-|-|-|v|-|-|-|.| }} | |||
{{familytree | | | A01 | | | | | | | | A02 | | | A03 | | | A04 | | | A05 | | | A06 | | A07 | | | A01 = '''Follicular neoplasm''' | A02 = '''FLUS''' | A03 = '''AUS''' | A04 = '''Benign''' | A05 = '''Suspicious for malignancy''' | A06 = '''Papillary thyroid carcinoma''' | A07 = '''Nondiagnostic'''}} | |||
{{familytree | | | |!| | | | | | | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | |!| | | }} | |||
{{familytree | | | |!| | | | | | | | | |`|-|v|-|-|'| | | | F01 | | | |`|-|-|v|-|'| | | F02 | | | | F01 = '''Repeat Ultrasound''' every 1-2 year <br> If growth more>20% or suspicious ultrasound results, consider '''FNA''' again | F02 = '''Repeat FNA with ultrasound guidance''' }} | |||
{{familytree | | | |!| | | | | | | | | | | S01 | | | | | |!|!|!| | | | | | S02 | | | | | | | | S01 = '''Repeat FNA''' in 2-3 months | S02 = '''Total thyroidectomy''' }} | |||
{{familytree | | | |!| | | | | | |,|-|-|-|-|^|-|-|-|-|.| |!|!|!| | | | | | | | | | | | | | | }} | |||
{{familytree | | | |!| | | | | | A01 | | | | | | | | A02 |'|!|!| | | | | | | | | | | | | | | | A01 = AUS <br> FLUS | A02 = '''Benign'''}} | |||
{{familytree | | | |`|-|-|-|v|-|-|'| | | | | | | | | | | | |!|!| | | | | | | | | | | | | | | | }} | |||
{{familytree | | | | | | | |!| | | | | | | | | | | | | | | |!|!| | | | | | | | | | | | | | | }} | |||
{{familytree | | | | | |,|-|^|-|-|.| | | | | | | | | | | | |!|!| | | | | | | | | | | | | | | }} | |||
{{familytree | | | | | R01 | | | R02 |-|-|-|-|-|-|-|-|-|-|-|'|!| | | | | | | | | | | | | | | | | R01 = '''Cold''', non-functional nodule | R02 = '''Hot''', functional, benign nodule}} | |||
{{familytree | | | | | | |!| | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | }} | |||
{{familytree | | | | | | R01 | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | R01 = '''Thyroid lobectomy''' considering ultrasound results <br> AND <br> '''Molecular diagnostic testing''' <br> *Gene expression classifier <br> * Mutational analysis}} | |||
{{familytree | | | | | | |!| | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | }} | |||
{{familytree | | | |,|-|-|^|-|-|-|-|-|-|.| | | | | | | | | | |!| | | | | | | | | | | | | | | }} | |||
{{familytree | | | W01 | | | | | | | | W02 |-|-|-|-|-|-|-|-|-|'| | | | | | | | | | | | | | | | | | | | | W01 = '''Suspicious to malignancy''' | W02 = '''Benign''' }} | |||
{{familytree | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }} | |||
{{familytree | | | A01 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | A01 = '''Lobectomy''' <br> OR <br> '''Total thyroidectomy''' based on the ultrasound evaluation }} | |||
{{familytree/end}} | |||
|} | |||
== References == | == References == | ||
{{Reflist|2}} | {{Reflist|2}} |
Revision as of 19:53, 8 September 2017
Thyroid nodule Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Thyroid nodule diagnostic study of choice On the Web |
American Roentgen Ray Society Images of Thyroid nodule diagnostic study of choice |
Risk calculators and risk factors for Thyroid nodule diagnostic study of choice |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]
Overview
Diagnostic criteria
- Thyroid function should be assessed in all patients with thyroid nodules.
- 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
- Subsequent evaluation is based upon the TSH level and sonographic features of the nodule(s)
- Thyroid scintigraphy is used to determine the functional status of a nodule.
- Scintigraphy utilizes one of the radioisotopes of iodine (usually 123-I) or technetium-99m pertechnetate. If available, radioiodine scanning is preferred.
Ultrasound indicating 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
Diagnostic approach
FIRE
Abbreviations:
TSH: Thyroid stimulating hormone, FNA: Fine needle aspiration, FLUS: Follicular lesion of undetermined significance, AUS: Atypia of undetermined significance.
|