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== Thyroid Nodule Differential Diagnosis ==
== Thyroid Nodule Differential Diagnosis ==
[[Neck masses]] can be mistaken with thyroid nodules. While the diagnosis of a thyroid nodule is established, thyroid nodule should be differentiated based on [[benign]] or [[malignant]] features and the type of nodule:
[[Neck masses]] can be mistaken with thyroid nodules. While the diagnosis of a thyroid nodule is established, thyroid nodule should be differentiated based on [[benign]] or [[malignant]] features and the type of nodule:
<small><small>
{| class="wikitable"
{| class="wikitable"
! colspan="2" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! colspan="2" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
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! align="center" style="background:#4479BA; color: #FFFFFF;" + |FT4/T3
! align="center" style="background:#4479BA; color: #FFFFFF;" + |FT4/T3
|-
|-
! rowspan="8" |<small> <small> Benign <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="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="pmid24396661">{{cite journal |vauthors=Kim KW |title=Natural course of benign thyroid nodules |journal=Endocrinol Metab (Seoul) |volume=28 |issue=2 |pages=94–5 |year=2013 |pmid=24396661 |pmc=3811718 |doi=10.3803/EnM.2013.28.2.94 |url=}}</ref></small> </small>
! rowspan="8" |Benign <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="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="pmid24396661">{{cite journal |vauthors=Kim KW |title=Natural course of benign thyroid nodules |journal=Endocrinol Metab (Seoul) |volume=28 |issue=2 |pages=94–5 |year=2013 |pmid=24396661 |pmc=3811718 |doi=10.3803/EnM.2013.28.2.94 |url=}}</ref>
!Colloid adenoma
!Colloid adenoma
|
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| ---
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|}
</small></small>


== References ==
== References ==
{{reflist|2}}
{{reflist|2}}
{{WH}}
 
{{WS}}
[[Category:Disease]]
[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Thyroid disease]]

Revision as of 19:35, 7 February 2019

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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

Neck masses can be mistaken with thyroid nodules. The most important neck masses that can be mistaken with thyroid nodules include: Thyroglossal duct cyst, parathyroid cancer, parathyroid cyst, and branchial cleft cyst. While the diagnosis of a thyroid nodule is established, thyroid nodule should be differentiated based on benign or malignant features and the type of nodule.

Thyroid Nodule Differential Diagnosis

Neck masses can be mistaken with thyroid nodules. While the diagnosis of a thyroid nodule is established, thyroid nodule should be differentiated based on benign or malignant features and the type of nodule:

Disease Nodule property Spread Nodular growth Laboratory Imaging Pathology Associated mutation special consideration
LN Vessel Metastasis TSH FT4/T3
Benign [1][2][3] Colloid adenoma
  • Noncancerous enlargement of thyroid tissue
  • May be painful
 - - - Intermediate

Slow

NL NL
  • Iso- to hypoechoic
  • May have internal cystic or heterogeneous change
  • May have calcification
  • Multiple echogenic foci (of inspissated colloid) with comet tail artifact
 --- May progress to carcinoma
Hashimoto's thyroiditis - - - Rapid

Intermediate

↓↓ ↓
  • Hypoechoic micronodules (1-6 mm) with surrounding echogenic septations
 May be accompanied with fever

Autoimmune disease of thyroid gland

Cysts nodule
  • Most common cause of painful neck lesion
 - - - Rapid

Intermediate

NL NL
  • Cystic non-calcified nodules
 - Mostly due to degenerating thyroid adenomas
Follicular adenoma
  • Rarely painful
 - - - Intermediate

Slow

↓↓ ↑
  • Thin peripheral halo
  • Predominantly cystic or mixed cystic and solid lesions
  • Isoechoic or predominantly anechoic
 ---
  • PAX8-PPAR gamma 1 
 ---
Hyperplastic nodule - - - Rapid

Intermediate

↓↓ ↑
Macrofollicular adenoma - - - Intermediate

Slow

↓↓ ↑
Microfollicular or cellular adenoma - - - Intermediate

Slow

↓↓ ↑
Hürthle cell adenoma - - - Intermediate

Slow

↑↓ ↑↓
Malignant[4][5][6][7][8] Papillary carcinoma
  • Fixed
  • Painless
 + + Intermediate

Slow

NL NL
  • Unencapsulated and may be partially cystic
  • Papillae consisting of one or two layers of tumor cells surrounding a well-defined fibrovascular core
  • Large, oval, and appear crowded and overlapping nuclei
  • May contain hypodense powdery chromatin, cytoplasmic pseudoinclusions due to a redundant nuclear membrane, or nuclear grooves
 ---
Follicular carcinoma
  • Fixed
  • Painless
 + +
  • Bone
  • Lung
 Intermediate

Slow

↑↓ ↑↓
  • Lesions are typically hypoechoic
  • Usually lacks cystic change
  • FLUS
  • Tumor capsule
  • Vascular invasion
  • RAS mutations
  • PAX8-PPAR gamma 1 
Medullary carcinoma Mainly manifest paraneoplastic symptoms: + -/+
  • Locally to neck
  • Can metastase to all body organ systems
 Intermediate

Slow

NL NL
  • Unifocal
  • May present as multifocal
 ---
  • May be associated with other co-existing diseases
  • Associated with high levels of calcitonin
Anaplastic carcinoma + + Slow ↓ ↑ Cytologically malignant:
  • Huge nuclear-cytoplasmic ratio
  • Mitosis
  • P53
  • BRAF
  • Very malignant, always considered as stage IV
Primary thyroid lymphoma + -
  • MALT lymphoma less aggressive
  • Diffuse large cell lymphomas more aggressive
 Intermediate

Slow

NL NL
  • BRAF
  • NRAS
  • MAPK 
Metastatic carcinoma
  • Thyroid and extra thyroid manifestations
 + + + Intermediate

Slow

↑↓ ↑↓ - - -
Thyroglossal duct cyst[9]
  • Mostly midline
  • Can be painful if get infected
 - - --- --- NL NL --- --- ---
Branchial cleft cyst[10] - +

May adhere to great vessels at the mandibular angle

--- --- NL NL --- --- ---
Neck abscess[11]
  • Painful mass in the neck, may be accompanied with erythema
 + - --- Rapid NL NL
  • Cyst with hyperechoic debris containing pus
 --- --- ---
Parathyroid cyst[12]
  • Painless mass
 - - --- Rapid

Intermediate

NL NL
  • Cystic lesion that is uniformly anechoic
 --- --- ---
Parathyroid cancer[13] + + +

Rarely distant metastases, mainly  thyroid gland, overlying strap muscles, recurrent laryngeal nerve, trachea, or esophagus

Slow

Intermediate

NL NL
  • Normal thyroid size with a complex echogenic structure
  • May contain hyperechoic solid part and several centrally located anechoic cavities
 ---

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ Kim KW (2013). "Natural course of benign thyroid nodules". Endocrinol Metab (Seoul). 28 (2): 94–5. doi:10.3803/EnM.2013.28.2.94. PMC 3811718. PMID 24396661.
  4. ↑ 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.
  5. ↑ Staunton MD, Greening WP (1973). "Clinical diagnosis of thyroid cancer". Br Med J. 4 (5891): 532–5. PMC 1587522. PMID 4800743.
  6. ↑ Sethi K, Sarkar S, Das S, Mohanty B, Mandal M (2010). "Biomarkers for the diagnosis of thyroid cancer". J. Exp. Ther. Oncol. 8 (4): 341–52. PMID 21222366.
  7. ↑ Hoang J (2010). "Thyroid nodules and evaluation of thyroid cancer risk". Australas J Ultrasound Med. 13 (4): 33–36. doi:10.1002/j.2205-0140.2010.tb00177.x. PMC 5024877. PMID 28191095.
  8. ↑ Bano G, Hodgson S (2016). "Diagnosis and Management of Hereditary Thyroid Cancer". Recent Results Cancer Res. 205: 29–44. doi:10.1007/978-3-319-29998-3_3. PMID 27075347.
  9. ↑ Yaman H, Durmaz A, Arslan HH, Ozcan A, Karahatay S, Gerek M (2011). "Thyroglossal duct cysts: evaluation and treatment of 49 cases". B-ENT. 7 (4): 267–71. PMID 22338239.
  10. ↑ Nahata V (2016). "Branchial Cleft Cyst". Indian J Dermatol. 61 (6): 701. doi:10.4103/0019-5154.193718. PMC 5122306. PMID 27904209.
  11. ↑ Bulgurcu S, Arslan IB, Demirhan E, Kozcu SH, Cukurova I (2015). "Neck abscess: 79 cases". North Clin Istanb. 2 (3): 222–226. doi:10.14744/nci.2015.50023. PMC 5175110. PMID 28058371.
  12. ↑ Ujiki MB, Nayar R, Sturgeon C, Angelos P (2007). "Parathyroid cyst: often mistaken for a thyroid cyst". World J Surg. 31 (1): 60–4. doi:10.1007/s00268-005-0748-8. PMID 17180630.
  13. ↑ Solomon PR, Pendlebury WW (1988). "A model systems approach to age-related memory disorders". Neurotoxicology. 9 (3): 443–61. PMID 3059245.
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