prep4usmle
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I would order the thyroid fuction tests (T3, T3, TSH) first. No reference, sorry.
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| jil
Forum Elite
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according to kaplan
1 st test is TSH if this normal then FNAC
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| bozhenka
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I think, it will be very good with solitary node to proceed the radioactive iodine scan, which distinguishes toxic adenoma from Grave's desease, and additional studies with antithyroid antibodies may be helpful. A hot nodule is usually benign.
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| dimps
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since the advent of FNAC radioactive iodine scanning are of less use ....according to CMDT
i agree with jil
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| tuesday
Forum Senior
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agreew/ TSH first. Want us to do the less invasive
& cost effective test first.
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| dnaprimase
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yeah TSH FIRST
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| dr.shar
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let me know, when do we use thyroid scan generally?
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| tuesday
Forum Senior
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Thyroid scan is one of the tests to establish the cause of Hyperthyroidism.
1. diffuse, homogenous dist. in GRAVES DSE.
(DIFFUSE TOXIC GOITER)
2.mult. areas of increased uptake in TOXIC MULTI-
NODULAR GOITER)
3. single area of increased uptake in TOXIC
ADENOMA)
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| Dot
Forum Senior
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harrison says 1st thyroid scan and if nodule is smaler than 1cm go for usg guided FNAC
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| miky
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Thyroid nodule - investigation plan:
1st - TFTs - TSH is most important - it will tell you whether the nodule is toxic / functional (usuallly not cancer)
next: Nuclear scan - cold vs hot nodule - a cold nodule does not take up active iodine (usually cancer suspected)
next: Fine - needle biopsy / Open biopsy (definitive dx) - it will tell you the histological features of this nodule (benign vs malignant)
However, there are also some clinical clues to the malignancy (which you must know very well) but which I'd dare to write down:
h/o prior irradiation to the neck (especially during childhood)
stony hard consistency
rapidly enlarging mass
cervical LAP
hoarseness (invasion of RLN)
difficulty breathing
skin ulcer
non-mobile with swallowing
In case you suspect a malignant nodule, you may go with Biopsy as the 1st option.
Hope it helped
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| lucky
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the first test to do is TSH , if this is normal then proceed with FNA.
[kaplan notes]
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| miky
Forum Senior
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Posts: 99
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sth. more for thyroid nodule / mass:
U/S of the neck is being more and more used to detect a thyroid mass / nodule. It also has the net advantage of being non-invasive and non-radiation-generating.
Needle biopsy can be U/S guided. It's easier. Also, CT-guided biopsy is an alternative, although more expensive.
Once you diagnose a thyroid malignancy, always proceed next with a full work-up or local / distant invasion and determine resectability chance.
CT scan of the neck and also of the chest (lung MTS) and abdomen (liver MTS) is a good option together with biochemical investigations such as: LFTs, CBC & differential, RFTs, ESR, serum electrolytes (Ca, PO4, Na).
However, the prognosis of a thyroid malignancy is intimately related to the histopathological pattern found at biopsy. So, biopsy is necessary not only in establishing the character of the tumor, but also in predicting survival and sometimes therapeutical inervention to consider.
Hope it helped.
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