Thyroid Nodules

• Prevalence 5-10% (20-60% if screen with U S), 5% malignant

• Features associated w t risk of malignancy: age < 20 or >70. male sex. h o neck XRT, fixed lesion, "cold nodule" on RAIU. large size, worrisome U S findings (hypoechoic. solid, irregular borders, microcalcifications. central blood flow), cervical LAN

• Features associated w benign dx: FHx of autoimmune thyroid disease or goiter, presence of hypo- or hyperthyroidism, nodule tenderness

• Screening U S recommended for those with FHx of MEN2 or medullary thyroid cancer.

personal h o neck XRT. palpable nodules or multinodular goiter

• FNA should be performed for nodules -10 mm with irregular borders, microcalcifications.

or chaotic intranodular vascular spots: FNA any nodules in Pts with h o neck XRT or FHx of MEN2 or MTC

Figure 7-2 Approach to thyroid nodulei (Endocr Proct 2006; 12:631

Thyroid nodule

RAIU

non-i

Likely benign toxic adenoma: ablate, resect, or med Rx

Suppressive Rx

Thyroid nodule

RAIU

non-i

Likely benign toxic adenoma: ablate, resect, or med Rx

Suppressive Rx

Suppressive Rx

Surgery

Likely benign toxic adenoma: ablate, resect, or med Rx

Suppressive Rx

. ^^does not resolve i ¥ Observe Surgery

Surgery

Likely benign toxic adenoma: ablate, resect, or med Rx

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