Solitary Thyroid Nodule

What is Solitary Thyroid Nodule?

Thyroid nodules are very common, and most are incidental findings during routine physical or imaging. Thyroid nodules identified as an incidental finding on diagnostic imaging do not require further evaluation unless they are palpable, greater than 1 cm in size, or both. The clinical importance of thyroid nodules is to exclude thyroid cancer, which accounts for about 5% percent of all thyroid nodules. Solitary Thyroid Nodules STN have a high possibility of being malignant and needs to be characterized properly for optimum management.

The prevalence of thyroid nodules becoming malignant is higher in some population which includes:

  • Children
  • Adults less than 30 years of age
  • History of head and neck radiation exposure
  • Family history of thyroid cancer

What causes Solitary Thyroid Nodules?

  • Multinodular goiter 
  • Thyroid cancer
  • Thyroid cyst
  • Iodine deficiency
  • Normal thyroid tissue overgrowth

What are the symptoms of Solitary Thyroid Nodules?

Most patients with Solitary Thyroid Nodules do not have symptoms except cosmetic issues as the nodules become large. It can cause symptoms such as shortness of breath or difficulty swallowing if the nodules become so large and press on the windpipe.

How to diagnose Solitary Thyroid Nodules?

  • History and physical examination: A careful medical history and physical examination should always be performed in the evaluation of Solitary Thyroid Nodules. Other diagnostic testing listed below are also performed.
  • Thyroid-stimulating hormone (TSH): A blood test to measure thyroid-stimulating hormone is usually the first step to determine if the thyroid gland is underproducing or overproducing the thyroid hormones.
  • Thyroid ultrasound:  All patients with a suspected thyroid nodule or nodular goiter on physical examination should have a thyroid ultrasound done as part of their diagnostic. work-up.   Thyroid ultrasonography is used to determine the size and the characteristics of the nodule and to select nodules that require an FNA biopsy.
  • Fine-needle aspiration (FNA):  It is the most accurate diagnostic procedure that can differentiate benign from malignant Solitary Thyroid Nodules. FNA procedure involves the placement of the needle in the nodule and aspiration of the cells into a syringe for pathological examination. The nodule is then classified as non-diagnostic, benign, suspicious, or malignant.
  • Thyroid Scan: A thyroid scan is only considered in patients with low TSH levels to determine if the nodules are autonomous or non-functional.

How to treat Solitary Thyroid Nodules?

Management of Solitary Thyroid Nodules FNA result and Bethesda classification.

Benign thyroid nodule:  No surgery is indicated. A careful monitor and repeated FNA are recommended if the nodules changes in size. A suppressive treatment using a trial of thyroid hormone can be used to shrink the nodule.

Malignant thyroid nodules:  The management of malignant thyroid nodules is based on Bethesda classification. A lobectomy or a total thyroidectomy to remove the thyroid gland followed by thyroid hormone suppressive therapy may be indicated.

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