DrVirgo
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Patient has a thyroid nodule.
TSH is LOW
RAIU Scan was done.
1. What is the next step if the scan shows a HOT nodule?
2. What si the next step if the scan shows a COLD nodule?
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| hero
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FNA - all thyroid nodules.
before FNA nodule should be non active, must cool it off.
than if cancer - surgery
if benign - watch
Nodule --> functioning or not? --> TSH
TSH normal --> FNA
i.e. if scan shows HOT nodule - PTU or methimisole antil it become cold, than FNA
if COLD - FNA
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| kpmle2
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1. What is the next step if the scan shows a HOT nodule? --Hot nodules are never cancerous --do nothing.
2. What is the next step if the scan shows a COLD nodule? --cancers are usually cold-- Do FNA . If FNA shows Ca --do surgery. If benine --watch.
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| cool doctor
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kpmle x2
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| DrVirgo
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kpmle2 wrote:
2. What is the next step if the scan shows a COLD nodule? --cancers are usually cold-- Do FNA . If FNA shows Ca --do surgery. If benine --watch.
I agree with you.
But does it depend on nodule size?
I remember UW said to do an FNA if Nodule is >1-1.5cm.
And another question is when would we use Ultrasound in the diagnosis of Thyroid nodule?
OK, for guiding FNA or for following growth, but
What about for the diagnosis of the nonpalpable nodule? would we use U/S? but if so then how would we know there is a nodule to begin with???
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| kpmle2
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Thyroid nodules are frequently discovered as an incidental finding.
U/S for thyroid nodules to measure the size of a nodule and to determine whether a palpable nodule is part of a multinodular goiter.
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| hero
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i want to make it clear
cold nodules are more likely to be malignant than hot, but this is not reliable.
also
A diagnosis of Hashimoto thyroiditis does not exclude the possibility of malignancy.
at the same time
Patients with solitary thyroid nodules associated with suppressed TSH levels, with overt or subclinical hyperthyroidism, do not require routine FNAB. In such cases, the patient may be referred to an endocrinologist to discuss iodine-131 treatment versus surgical intervention.
so, in hot nodule and clinical suspicion for Hashimoto thyroiditis, obtain serum antithyroid peroxidase (anti-TPO) antibody and antithyroglobulin (anti-Tg) antibody levels. but A diagnosis of Hashimoto thyroiditis does not exclude the possibility of malignancy.
confused.
esp after kaplan's lecture which made accent on that point: every nodule -->FNA
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| DrVirgo
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hero wrote:
i
confused.
esp after kaplan's lecture which made accent on that point: every nodule -->FNA
Yes, thats what I found confusing too... First he said Check TSH first and only if it's normal, do FNA.
If cancer --> surgery,
and if Benign--> Observe.
If Follicular cells --> Surgery (because we ca't tell between follicular adenoma and Follicular Cancer.
If FSH is Decreased, means its HYPERthyroid and these are rarely malignant. so DON'T do an FNA.
But then he said if they give you a Scan and say there is a hot or cold nodule, DO FNA.
But UW says: HOT NODULE on Scan--> DON'T do FNA
So I assume COLD NODULE on Scan --> DO FNA???
About Hashimotos, like you said we can't rule out cancer. so in this case if we get a HIGH TSH, measure the T4.. IF T4 is decreased and you also see the patient has Thyroid Antibodies (antimicrosomal), the Dx is Hashimotos... A patient with Hashimotos can also have a thyroid nodule so in this case if the Nodule is >1-1.5 cm, DO FNA.
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| neurom
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Ok guys, this is a guidelines (American Association of Clinical Endocrinologists):
Palpable nodule ---> TSH and U/S:
1. High TSH----> + U/S not suspicious---> thyroid peroxidase antibody ----> levothyroxine
High TSH----> + U/S suspicius----> FNA
2. Normal TSH----> FNA
3. Low TSH---->Scintigraphy: cold - FNA, hot - multinodular goiter or single nodule
FNA results:
1. Benign----> cystic, solid
2. Malignant or suspicious---->surgery
3. Follicular neoplasia----> scintigraphy: cold----> surgery, hot----> follow-up
If the nodule is found incidentally by U/S:
again TSH:
1. Normal: <10mm and no risk factors+ U/S is not suspicious ----> follow-up, if U/S is suspicious - FNA
>10 mm or risk factors-----> FNA
2. High: US suspicious----> FNA, U/S not suspicious----> thyroid peroxidase antibody and levothyroxine.
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