Thyroid Nodules and Multinodular Goiter

Question 1

General Considerations

Answer 1

Thyroid nodules are extremely common
Palpable nodules are found in 5% of women & 1% of men in iodine-sufficient areas; more common in iodine-deficient areas
US - ~ 275,000 nodules detected by palpation; 10% malignant
Increasingly prevalent with age
50% of palpable “solitary nodules” are one nodule in a multinodular goiter
Most patients with a nodule are euthyroid

Question 2

Signs & Symptoms

Answer 2

Most small nodules cause no symptoms
May grow to become visible
Large nodules
Discomfort
Hoarseness
Dysphagia
May be associated with hypo- or hyperthyroidism

Question 3

DD

Answer 3

Cysts
Carcinomas
Goiters
Hashimoto's thyroiditis
subacute thyroiditis
Surgery or radiation 	effects
Parathyroid cysts or 	adenomas
Thyroglossal cysts
Nonthyroidal lesions
Lymphomas

Question 4

Factors Suggesting Malignant Dx

Answer 4

Age younger than 20 years or older than 70 years
Male sex
Associated symptoms of dysphagia or dysphonia
History of neck irradiation
Prior history of thyroid carcinoma
Firm, hard, or immobile nodule
Presence of cervical lymphadenopathy

Question 5

Factors Suggesting Benign Dx

Answer 5

Family history of autoimmune disease (eg, Hashimoto thyroiditis)
Family history of benign thyroid nodule or goiter
Presence of thyroid hormonal dysfunction (eg, hypothyroidism, hyperthyroidism)
Pain or tenderness associated with nodule
Soft, smooth, and mobile nodule
Continue to workup the nodule so that a carcinoma is not missed

Question 6

Dx Workup

Answer 6

TSH - if low, thryroid scan
Good H&P
Diagnostic U/S - determine characteristics of nodule
Refer for Fine needle aspiration

Question 7

Management

Answer 7

Will vary by findings of diagnostic tests
Follow
Repeat testing
Ablation
Surgical removal
From the PCP
Initial workup
Referral
Surveillance