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Thyroid nodules

Background knowledge ๐Ÿง 

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 and pathophysiology

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

Types

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

Clinical Features ๐ŸŒก๏ธ

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 ๐Ÿงช

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 ๐Ÿฅผ

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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