karusmle
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what is the first step in the management of thyroid nodule???
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| sachida
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I would say TSH levels
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| achilles
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should be measuring the TSH level first and then other tests.
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| sachida
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I think so for all thyroid related pathology- expecially nodule. I am still little unsure if it is carcinoma.
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| MAZI
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if the person has sign and symptom of hypo or hyperthyroid then TSH
if not the first is fine needle aspiration( FNA)
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| zeloc
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I am pretty sure that the first step is fine needle aspiration for a thyroid nodule in the asymptomatic patient, but there is a USMLEWORLD question that states the first step is to get a TSH. Any other opinions? I may look for a more definitive source tonight.
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| doyoudig
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TSH always 1st, u can;t really do much until u know the status of the Nodule
can be hot can be cold can be normal....
depending on its results - FNA comes next for cold/normal or
RAIU Scan to different btw Hot nodules etiologies
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| doyoudig
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http://www.merck.com/mmpe/sec12/ch152/ch152b.html
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| new_n_lost
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Fine-needle aspiration biopsy should be the first test performed in a euthyroid patient with a solitary thyroid nodule; radionuclide scanning should be reserved for patients with indeterminate cytologic findings or thyrotoxicosis.
http://content.nejm.org/cgi/content/full/328/8/55...
This is for Euthyroid Pt Otherwise they have suggested tht :-
Because clinical examination is not sensitive for identifying thyroid dysfunction, laboratory evaluation of thyroid function is routinely warranted. The only biochemical test routinely needed is measurement of the serum thyrotropin level. If this level is subnormal, levels of free thyroxine or free triiodothyronine should be measured to document the presence and degree of hyperthyroidism. Approximately 10 percent of patients with a solitary nodule have a suppressed level of serum thyrotropin, which suggests a benign hyperfunctioning nodule. If the serum thyrotropin concentration is elevated, a serum antithyroperoxidase antibody level should be obtained to confirm Hashimoto's thyroiditis. However, the finding of an elevated level does not obviate the need for a fine-needle aspiration biopsy, since the practitioner must rule out a coexisting cancer, including lymphoma, which accounts for only 5 percent of thyroid cancers but is associated with Hashimoto's thyroiditis. Nearly all patients with thyroid cancer are euthyroid,
Attached Files:
DD in Thyroid Nodule.gif (14 KB, 12 downloads)
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| doyoudig
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I disagree, so also looked this up in Cmdt 2007 ed
" Thyroid Nodules are indications for Thyroid Function Test. Serum TSH (very sensitive) and FT4 are preffered."
to new n lost:
so if u say that the Pt is euthyroid, then u alwready know the TSH levels!!!
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| new_n_lost
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Dude, I just posted u the Link and their reasoning U can disagree with them but if u see the line right where i have said " FOR EUTHYROID PT OTHERWISE " u will get the point they r trying to make. They have categorically explained wht they do in such cases of thyroid Nodule.
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| doyoudig
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new n lost no worries, I was writing response to ur 1st post n once I posted I saw ur sencond post
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| new_n_lost
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doyoudig wrote:
new n lost no worries, I was writing response to ur 1st post n once I posted I saw ur sencond post
 lol that was wht i was thinking
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| liliaeliz
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first next step TSH
most accc. FNA
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| Justice
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TSH levels
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| epica
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I think it's incomplete Q.
I would refer to CMDT 2007
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| dr in trouble
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First step is always to check TSH first as u can not do FNA for a hyperthyroid pt.,once u r sure that pt is euthyroid then u can go for FNA .
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| Justice
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Well, I went through this issue yesterday, and it seems like FNA is the best step to study thyroid node... All other steps depend upon findings on FNA... Both StepUp and FA agree on this...
If the node is hyperfunctional, the TSH will be low... I don't think it'll say anything specific about diagnosis... You rather do a radio-I scan...
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| lakshya_0_7
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u know what guys....pretest surgery says USG of neck is first....more confusion
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