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INVESTIGATIONS

OF THYROID
LUMPS

Thyroid Gland

Thyroid Lump
Mass in front of the neck
Due to enlargement of thyroid gland
Known as Goiter
Can be

1- Diffuse
2- Nodular

Causes of thyroid lump


Diffuse:

Simple diffuse
Auto-immune
Thyroiditis
Iodine deficiency
Goitrogens
Dyshormogenesis
Nodular:

Solitary
Multi-nodular
Cystic
Fibrotic

Tumours:
Adenomas
Carcinomas
Lymphomas
Miscellenous:
Sarcoidosis
Tuberculosis

Symptoms
Swelling in the neck:
Small or large
Asymptomatic or painful
May compress nearby structures and cause:
Airway obstruction
Dysphagia
Coughing or wheezing
Hoarseness of voice

History
The patient may present with :
Swelling in the neck:
Seen by the patient or on routine physical exam
Referred as an incidental nodule on imaging
Age
Dysphagia, stridor, hoarseness
Pain
Change in size of the lump
Symptoms of hypothyroidism or hyperthyroidism
History of previous radiation
Family history of thyroid cancer

Examination
Inspection
Palpation
Percussion
Auscultation

Blood Tests
THYROID FUNCTION TEST:
Functional status of thyroid gland
Euthyroidism, hypothyroidism or hyperthyroidism
Measure serum TSH, free T3 and T4

T3
Normal levels/Euthyroid
Primary Hypothyroidism
Secondary Hypothyroidism
Primary Hyperthyroidism
Secondary Hyperthyroidism

( 2.3-4.2 ng/dL)

T4
(0.8-2.8 ng/dL)

TSH
(0.3-5.0 U/mL )

Blood Tests
Serum Thyroglobulin:
Protein found in thyroid cells
Use: Follow up cases of thyroid Ca after surgery
Ref range: 0-30 ng/mL
Thyroglobulin Autoantibodies:

Ref range: <116 IU/mL


High serum titre in autoimmune thyroiditis
Also found in 10-20% of healthy individuals

Serum Calcitonin:
Use: Suspected medullary carcinoma

Fine Needle Aspiration


Cytology/Biopsy ( FNAC/FNAB)
Histopathological diagnosis of suspicious

nodule
Gold standard
High sensistivity/specificity- upto 90%
US guided FNAC/FNAB further inc. accuracy
Aspiration may be reported as:
i. Benign
ii. Malignant
iii. Suspicious
iv. Non diagnostic

FNAC

Rapidly growing cystic thyroid nodule with tracheal


compression symptoms. Brown fluid was aspirated
but it refilled

ULTRASOUND
Widely used imaging technique
Uses:
i.
ii.
iii.
iv.
v.
vi.

Identify nodule even of a few mm


Differentiate b/w solid and cystic
Shows number and consistency of nodules
Accurate size of nodule(s) and their location
Associated cervical lymph nodes
Vascularity of thyroid gland or nodules

Medullary
carcinoma

Medullary
carcinoma

Thyroid Scan
Uses Tc99m, I123, I131
Functional status of nodule in relation to surrounding

tissues.
Can differentiate between:
(frequency)
(malignancy)
Hot (hyperfunctioning) nodules
Cold(hypofunctioning) nodules

5%
80%

10%
1%

X RAYS

CT SCAN/MRI
Imaging technique
Not as routine
Large goiter
Extent of retrosternal extension
assesing neck nodes
Tracheal compression

CT SCAN

MRI

THANKYOU