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Introduction
Diagnostic Procedure
The Management
Introduction
Is a discrete lesion within the thyroid gland that is palpably
thyroid parenchyma.
Thyroid incidentalomas
Non palpable nodules are easily seen on ultrasound or
other anatomic imaging studies.
Palpable solitary nodules of the thyroid gland :
USA UK
WOMEN 6.4 % 1.5 %
MEN 5.3 % 0.8 %
• Nodules must approach 1 cm in diameter to be recognized on
palpation.
• + 50 % of 60 years old persons have thyroid nodules.
Castro MR. 2005; ATA 2006 ; Wartofsky L. 2008
Generally, only nodules larger than 1 cm should be
Malignant
85 – 95 %
Benign
BENIGN ( 85 – 95% )
MALIGNANT ( 5 – 15 % )
Clinical Exam
No Suspicious
Suspicion for Malignancy
Suspicious for malignancy :
• Low
• Normal/High
No Suspicious
Clinical Exam
Suspicion for Malignancy
Serum TSH
Level
Low Normal/High
No TSH Suppression
Lobectomy
Thyroid Nodule
No TSH Suppression
Isthmolobectomy
Thyroid Nodule
• Clinical Examination : Suspicious for
Malignancy
• Thyroid Sonography : Intermediate Suspicion
Pattern
• FNA : AUS / FLUS
• Size / Unilateral : 5 cm
ATA
Guidelines
Thyroid
2015
PERSONALIZED TREATMENT
LOBECTOMY
Thyroid Nodule
• Clinical Examination : Suspicious for
Malignancy
• Thyroid Sonography : High Suspicion Pattern
• FAC : Malignant
• Size / Unilateral : 5 cm
ATA
Guidelines
Thyroid
2015
TRADITIONAL PARADIGM
PERSONALIZED TREATMENT
TOTAL THYROIDECTOMY
Neck sonography features of Lymph nodes, predictive of malignant
involvement
Sign Reported Sensitiviy % Reported Specificity %
MIcrocalcification 5 – 69 93 - 100
Cystic aspect 10 - 34 91 - 100
Peripheral Vascularity 40 - 86 57 - 93
Hyperechogenicity 30 – 87 43 - 95
Round Shape 37 70
Haugen ,BR (ATA) 2015
• Clinical Examination : Suspicious for
Malignancy
• Thyroid Sonography : High Suspicion
Pattern
• Neck Sonography : Cystic Aspect and
Peripheral
Vascularity
• FAC Thyroid : Malignant
• Size/ Unilateral : 5 cm
• Lymph Nodes : Level III, 2 and 4 cm
Thyroid : Total Thyroidectomy
Lymph Nodes : Open Biopsy
( Frozen Section )
Positive Malignancy
Right RND
• Lobectomy / Isthmolobectomy
No Levothyroxin Subtitution
Thyroid Neck Sonography ( every years )