• Approach to Thyroid Nodule:
  • 3 Things to Consider
    • Toxic Nodule --> Check TSH
    • Assess for Compressive Symptoms
    • Cancer
  • Check TSH
    • If low, check FT4 and T3
    • Get radioactive iodide uptake scan
    • If normal, look at U/S
  • Thyroid U/S for Size
    • Features on U/S can predict risk of malignancy
  • Depending on Size --> FNA
  
  

  Posted 04/19/17 10:41:14 AM by Ying Liu

• Four types of Thyroid cancer: Papillary, follicular, medullary and anaplastic
  • Papillary and Follicular are most common and treated similarly. 
  • Incidence of papillary cancer is increasing (4.8 to 14.9 per 100,000)
  • Risk factors include radiation and family history
  • Typically presents as a thyroid nodule noticed on exam
  • Prognosis extremely affected by age with patients diagnosed between 20-45 years having the best long-term prognosis (death rarely occurring in 30 year follow-up periods)
  
  

  Posted 04/19/17 10:41:34 AM by Ying Liu

• Treatment:
  • Surgery is preferred management. For tumors <1cm, lobectomy is preferred but for larger tumor total thyroidectomy may be preferred
  • Most patient will need thyroid hormone to suppress TSH stimulation of tumor growth. TSH goals depend on presence of thyroglobulin antibody levels
  • Radioiodine therapy (RAI) can be administered after thyroidectomy to ablate residual thyroid tissue and micrometastatic disease
  • Overall prognosis is very good
  
  

  Posted 04/19/17 10:41:52 AM by Ying Liu

• For further reading...

  ATA Guidelines for Thyroid Nodules
  
  

  Posted 04/19/17 10:43:00 AM by Ying Liu

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