Thyroid Nodule Flashcards
(18 cards)
raise the suspicion for thyroid cancer
younger than 20 years or older than 70 years
male sex
local compressive
infiltrative symptoms such as hoarseness or dysphagia,
firm and/or immobile nodule
nodules larger than 3 to 4 cm
cervical lymphadenopathy
history of neck irradiation
history of thyroid cancer in first-degree family members
suspicion for a hyperfunctioning nodule or toxic adenoma
palpitations
atrial fibrillation
anxiety
insomnia
weight loss
heat intolerance
diaphoresis
increased defecation
benign neoplasms
colloid nodules
degenerative cysts
nodular hyperplasia
follicular or Hürthle cell adenomas
patients with hyperthyroidism and thyroid nodules
nuclear medicine thyroid scintigraphy and ultrasound are recommended
one must assess for and document in every ultrasound.
1) parenchymal pattern and overall thyroid gland size
2) presence, size, location, and characteristics of any nodules
3) presence/absence, size, location, and characteristics of any suspicious cervical lymph nodes.
Thorough examination must be performed particularly of
pretracheal and paratracheal nodes of the central neck and mediastinum (levels VI and VII, respectively)
as well as the lateral jugular chain nodes
(levels IIa/IIb, III, IV, and Vb).
confer the highest risk of malignancy—specifically PTC—
1) the presence of microcalcifications
2) hypoechogenicity
3) irregular margins
4) a taller-than-wide
Intranodular vascularity
correlated with FTC More than PTC.
Appearance decreases the risk of malignancy.
spongiform pattern or a purely cystic appearance dramatically decrease the risk of malignancy.
TIRADS Depends on 5
nodule composition
echogenicity
shape
margin
and echogenic foci
ATA and TIRADS both Dont do FNA for
Neither system recommends routine FNA biopsy of nodules less than 1 cm
How FNA Performed
FNA is performed with a small-gauge needle
(typically 23–27 gauge)
and it may be performed with capillary or suction technique
Under US Guidance
Risk factors other than sonographic profile can reduce the threshold for performing FNA biopsy
positive family history of thyroid cancer
history of significant radiation exposure
and PET-positivity.
the Bethesda System for Reporting Thyroid Cytopathology 6
1) nondiagnostic/unsatisfactory
2) benign
3) atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS)
4) follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), which also encompasses Hürthle cell neoplasm;
5) suspicious for malignancy
6) malignant
Bethesda system
see
benign (Bethesda category II) and malignant (Bethesda VI) are highly accurate with an error rate of less than
3%
(Bethesda III and IV, respectively)—are associated with a cancer risk anywhere from
6% to 40%
Bethesda III nodules falling in the 6% to 30% range
the Bethesda IV nodules in the 10% to 40% range.
Molecular Test
DNA or RNA-based assays for creating molecular profiles
two most prominent tests are the Afirma and ThyroSeq
High NPV»_space; They can Rule out Malignancy
