Approach to Thyroid Nodule
Approach to Thyroid Nodule
2022-05-20 09:57:13/ Kategori : General Surgery
The thyroid gland is a small, butterfly-shaped gland located in the midline of the neck, under the cartilage protrusion called “Adam’s apple”. Although it weighs only 25 grams, it plays a fundamental role in growth and development with the hormones it secretes. The thyroid gland is also called the ‘regulator of all body functions’. Thyroid nodules are abnormal tissues that form within the thyroid gland and that do not resemble the normal tissue of the gland, may be chickpea or even larger, walnut-sized. 50% of the nodules are single nodules and 50% are multiple nodules. Palpable thyroid nodule is present in 4-7% of the adult population and is more common in females. The importance of the nodule for the clinician; It is the first sign of thyroid cancers or the possibility of developing cancer. The probability of developing cancer from the nodule is between 9% and 13% in patients without any risk factors. This rate increases even more if risk factors are present. To give an example, conditions such as radiation exposure to the head and neck in childhood, family history of thyroid cancer, rapid growth of the nodule, hoarseness, enlarged lymph nodes in the neck (LAP) are the conditions that increase the possibility of malignancy of the nodule.
What should be done in people with nodules in the thyroid gland?
First of all, patients should be examined in detail and a good anamnesis should be taken.
Thyroid USG
Thyroid function tests (FT3, FT4, TSH)
FNAB (Fine Needle Aspiration Biopsy) according to USG findings
Thyroid scintigraphy should be performed when necessary.
In which cases FNAB (Fine Needle Aspiration Biopsy) should be performed?
FNAB in thyroid nodules is performed according to USG findings regardless of the number of nodules. Accordingly, the size of the nodule and the USG risk classification are revealed. If patients have a pure cystic nodule, FNAB is not required. In case of low and moderate suspicious findings, FNAB should be performed for nodules larger than 1-1.5 cm, and FNAB over 1 cm is recommended for highly suspicious nodules. Nodules can be seen as cold (hypoactive), hot (hyperactive) and warm (normoactive) in scintigraphy. 70-80% of the nodules are cold nodules, 10% are hot nodules, and 10% are warm nodules. The cancer rate is higher in cold nodules. The cancer probability of hot nodules is considered very low. In cold nodules, the cancer rate varies between 5 and 7 percent. Today, thyroid scintigraphy is preferred in cases where abnormal thyroid hormone levels are detected. FNAB is recommended for cold nodules, regardless of size.
Surgical treatment:
The pathology result of Fine Needle Aspiration Biopsy performed from the nodule is of great importance in terms of how the treatment will be performed. If there is a suspicion of cancer or cancer as a result of the biopsy pathology, surgery is recommended to the patient. Thyroid hormone therapy (Tefor or Levothyron) can be performed in benign nodules that are not cancerous, or only follow-up can be done without medication. Generally, if the diameter of the nodule is larger than 3 cm, it is getting larger, if there is rapid growth and if there are lymph nodes in the neck, surgical treatment (surgery) is appropriate because the risk of cancer increases.
