Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

Thyroid Nodules and Cancer 1427

■Sudden appearance

■Growth rate of nodule

■Hoarseness, dysphagia

■Cervical adenopathy: present or absent

■Elevated temperature or BP

tests

Laboratory

■Basic blood tests: free T4, TSH

■Specific Diagnostic Tests

➣FNA biopsy

➣Blood:

➣Calcitonin: if FNA shows medullary CA

➣Calcium: if nodule is parathyroid or if clinical suspicion of hyper-

parathyroidism

➣Thyroglobulin: to follow treatment of papillary or follicular thy-

roid CA

Imaging

■I-123 uptake and scan (if TSH low)

■Thyroid US (if diagnostic uncertainty or to follow growth)

differential diagnosis

■Benign nodules:

➣Cysts: simple, infected, hemorrhagic, thyroglossal duct

➣Solid: follicular adenoma, thyroiditis, parathyroid adenoma

■Malignant nodules:

➣Well-differentiated: papillary CA, follicular CA,

➣Not well-differentiated: medullary, anaplastic, other (rare)

management

What to Do First

■Assess for likelihood of malignancy, infection, hemorrhage

■Consider FNA or surgical resection

General Measures

■Assess for possibility of hyperparathyroidism or pheochromocytoma

■Assess for general risks of surgery

specific therapy

■Drainage by FNA: benign, hemorrhagic, or infected cysts; antibiotics

for suppurative infection