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1、EvaluationofThyroidNodulesEricOliverAugust30,2007ObjectivesDiscussCommonCausesofThyroidNodulesHighlightApplicationofImagingStudiesinEvaluationoftheThyroidNoduleTheThyroidNoduleItisestimatedthattheprevalenceofthyroidnodulesinthegeneralpopulationis4-7%.Benignadenomasorcystsaccountfora
2、pproximately90%ofdetectedthyroidnodules.IntheU.S.,~10,000to17,000newcasesofprimarythyroidcancerarediagnosedeachyear.1,000-2,000peopledieeachyearfromprimarythyroidcarcinomas.CausesofThyroidNodularityBenignFollicularAdenomasMultinodulargoiter(colloidadenoma)Hashimoto’sthyroiditisCysts
3、(colloid,simple,hemorrhagic)CausesofThyroidNodularityMalignantPapillaryCarcinomaFollicularCarcinomaMedullaryCarcinomaAnaplasticandpoorlydifferentiatedcarcinomaPrimarylymphomaofthethyroidMetastaticcarcinoma(especiallybreastandrenalcellcarcinoma)LowSuspicionFamilyhistoryofautoimmunedi
4、sease(eg,Hashimoto’sthyroiditis)FamilyhistoryofbenignthyroidnoduleorgoiterPresenceofthyroidhormonaldysfunctionPainortendernessassociatedwithnoduleSoft,smooth,andmobilenoduleHegedus:NEnglJMed,Volume351(17).October21,2004.1764-1771Case1A16yearoldfemaleisseenbecauseofa6monthhistoryoffa
5、tigue,nervousness,tremor,heatintolerance,polyphagiaandweightloss.Herscholasticworkhasdeclinedinquality.Recentlyshenoticedsomeenlargementofherneckandprominenceofhereyes.Physicalexaminationreveals:B.P.130/60mmHg.,pulse96/minute,smoothwarmskin,eyelidretraction,symmetricthyroidenlargeme
6、nt,finehandtremorandmildmuscleweakness.HerTSHislow.LowTSHSuspectindependentlyfunctioningthyroid~10percentofpatientswithasolitarynodulehaveasuppressedlevelofserumthyrotropinNextStep:ScintographyRadionuclideScanningUsedtoidentifywhetheranoduleisfunctioning.Functioningnodulesarenearlya
7、lwaysbenignApproximately90percentofnodulesarenonfunctioning5percentofnonfunctioningnodulesaremalignantThus,inthepatientwithasuppressedlevelofserumthyrotropin,radionuclideconfirmationofafunctioningnodulemayobviatetheneedforbiopsy.ScintigraphyUsuallyeitherTechnetiumorRadioiodineNormal
8、follicularcellswill
