Title: Thyroid Nodule
Presenter(s): Dr. Sana Ghaznavi
Date: March 8, 2020
PEARL: When you suspect a thyroid nodule
Is there really a mass present? Soft tissue (e.g. skin folds); normal neck anatomy (tracheal rings, thyroid cartilage, hyoid bone)
Is the mass inside the thyroid or outside the thyroid? Extrinsic lesions (thyroglossal duct cyst, lymph nodes, parathyroid gland)
Is the thyroid mass focal or diffuse? Diffuse enlargement (hyperplasia e.g. goitre from iodine deficiency, inflammation e.g. Hashimoto’s thyroiditis, other pathology e.g. lymphoma, large nodule occupying the entire thyroid lobe)
Focal lesion: a thyroid nodule!
PEARL: Ddx thyroid nodule
Benign: benign (adenomatous) nodule, autonomous (“hot”) nodule, cyst
Malignant: primary thyroid cancer (papillary 85%, follicular 5-10%, anaplastic < 1%, medullary 3-5%), other (metastatic from another site - uncommon, primary is usually known; lymphoma - rare)
PEARL: Top reasons NOT to order a neck US
Abnormal thyroid function tests (high or low TSH) OR
Positive Anti-TPO antibodies (NB: titres do not matter, for Hashimoto's disease, tx with thyroid supplementation anyway)
Symptoms of hypothyroidism (e.g. fatigue, weight gain, cold intolerance)
In the ABSENCE of a palpable abnormality in the thyroid
PEARL: Choosing Wisely: A Brief Interlude Into Thyroid Labs for Workup of a Thyroid Nodule
Screen with TSH only (no free T4 or free T3 needed)
No role for TPO antibodies (Hashimoto’s thyroiditis)
No role for TSH receptor antibodies [TRAB] (Graves disease)
DISCLAIMER: This post contains my interpretation of the presentation. This post is not intended as medical advice. If you have medical concerns, contact a health care provider for assessment. If there are any copyright concerns, please contact me directly to remove the relevant material.
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