Thyroid Nodules – Diagnosis And Treatment

Thyroid Nodules – Diagnosis And Treatment

Write short note on solitary thyroid nodule.

Answer.

• It is the end stage result of diffuse goiter.
• Almost all the thyroid swellings initially present as solitary nodule.
• Solitary thyroid nodule is a discrete lesion/nodule within the thyroid gland and or radiologically distinct from surrounding thyroid parenchyma.

Solitary thyroid nodule Types

• Toxic solitary nodule—3—5% of solitary nodules of thyroid Nontoxic solitary nodule.

Based on radioisotope Study

• Hot: Means autonomous toxic nodule. Normal surrounding thyroid tissue is inactive and so will not take up isotope.
• Nodule is overactive. It is 5% common of which only 5%can be malignant.
• Warm: Normally functioning nodule. Nodule and surrounding normal thyroid will take up the isotope (active).
• It is l0% common of which l0% can be malignant.
• Cold: Nonfunctioning nodule; may be malignant (need not be always).
• Nodule will not take up isotope (underactive).
• It is 80% common of which 20% are malignant.

Solitary thyroid nodule Etiopathogenesis

• Puberty or pregnancy nodule
• Iodine deficiency nodule
• Adenoma
• Carcinoma
• Cyst.

Solitary thyroid nodule Clinical Features

• Common in female, seen in age group 20-40 year.
• Long duration of swelling in front of neck, dyspnea,dysphagia.
• Various obstructive signs are present i.e. stridor, tracheal deviation,
• neck vein engorgement.
• Single nodule is present.
• Hard area may suggest calcification and soft area necrosis.
• Sudden increase in size may occur due to hemorrhage.
• Solitary nodule has more tendencies to change in malignancy then
• MNG (multi-nodular goiter).

Solitary thyroid nodule Complication

• Calcification in long-standing.
• It may change into MNG (multi-nodular goitre).
• Sudden hemorrhage causes sudden enlargement of gland and even
• causes dyspnea.
• Patient may develop secondary thyrotoxicosis.

Solitary thyroid nodule Investigations

• Thyroid scan: This is basically a radioactive scan which makes out a hot or cold nodule.
  Hot nodules are not malignant and are toxic while cold nodules are malignant but they can be a simple cyst.
• Thyroid function tests: T3, T4 and TSH are not of use as most of the nodules are euthyroid.
• Ultrasound: It shows either cystic or solid nodule. Solid swellings can be edema or carcinoma.
• FNAC: It shows benign or indeterminate or malignant and at times it is undiagnostic also.
• Power Doppler can be done to know vascularity of the gland. Vascularity is described in resistive index.
• Serum calcitonin estimation is done if FNAC confims medullary carcinoma.
• CT scan or MRI can only be done in selective cases.
• X-ray of neck is done to see tracheal deviation.

Solitary thyroid nodule Management

• Non toxic benign nodule is treated with observation without any therapy.
  There is no role of any hormone therapy (L thyroxine).
  Annual clinical examination and ultrasound neck is needed during essential follow-up—any nodule of 20% increase in size or more than 2 mm increase in diameter warrants a repeat FNAC and hemithyroidectomy may be considered.
  Compressive symptoms and cosmesis are the indications for surgery,i.e. hemithyroidectomy.
• Solitary toxic nodule needs initial antithyroid drugs and then radioactive iodine therapy (5 m curie); occasionally surgery is done, i.e. hemithyroidectomy.
• During thyroid surgery complete thyroid gland should be explored properly.
  Care to be taken not to miss any similar nodule in any other part of gland.
  If there are no nodules and only solitary nodule is found it is resected with normal surrounding thyroid tissue, i.e. resection enucleation.
• If nodule is situated at junction of isthmus and the lobe, hemithyroidectomy is done.
  Histopathology of excised nodule is done. In histopathology report if there is presence of any evidence of malignancy immediate total thyroidectomy is done.