Thyroid nodules

Medicine > Endocrine & metabolic

Background knowledge 🧠

Definition

Thyroid nodules are discrete lumps within the thyroid gland.
Can be single or multiple.
May be benign or malignant.

Epidemiology

Prevalence: Found in 5% of the UK adult population on palpation.
Higher prevalence with age.
More common in women.
Approximately 5-15%of nodules are malignant.

Aetiology

Iodine deficiency.
Genetic factors.
Radiation exposure.
Autoimmune thyroid disease (e.g. Graves disease).
Growth of normal thyroid tissue, cysts, or tumours.

Types

Benign nodules: Colloid nodules, hyperplastic nodules, thyroid cysts.
Malignant nodules: Papillary carcinoma, follicular carcinoma, medullary carcinoma, anaplastic carcinoma.

Clinical Features 🌡️

Symptoms

Often asymptomatic and found incidentally.
Neck lump.
Compression symptoms: Dysphagia, dyspnoea, hoarseness.
Hyperthyroidism or hypothyroidism symptoms if functional.

Signs

Palpable nodule on neck examination.
Lymphadenopathy if malignant.
Signs of hyperthyroidism or hypothyroidism.
Tracheal deviation or obstruction in large nodules.

Investigations 🧪

Tests

Thyroid function tests (TFTs): TSH, Free T4, Free T3.
Ultrasound scan: To assess nodule characteristics and guide fine-needle aspiration (FNA).
Fine-needle aspiration (FNA): For cytology to determine malignancy.
Radioiodine scan: Differentiates between hot and cold nodules.
CT/MRI: For large or invasive nodules.

Management 🥼

Management

Watchful waiting for benign asymptomatic nodules.
Thyroid hormone suppression therapy for benign nodules with hyperthyroidism.
Radioactive iodine for toxic nodules.
Surgical removal for suspicious, malignant, or symptomatic nodules.
Refer to endocrinologist and/or surgeon for further management.

Complications

Malignancy.
Thyrotoxicosis.
Compression of surrounding structures.
Post-surgical complications: Hypoparathyroidism, recurrent laryngeal nerve injury.

Prognosis

Benign nodules have an excellent prognosis with appropriate management.
Prognosis of malignant nodules depends on type and stage at diagnosis.
Regular follow-up is essential for early detection of complications.

Key points

Thorough history and physical examination are crucial.
Use ultrasound and FNA for assessment.
Management depends on nodule characteristics and patient symptoms.
Multidisciplinary approach often required.

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