Clinical evaluation of patients with thyroid nodules
NICE suggest to only consider ultrasound for adults with thyrotoxicosis if they have a palpable thyroid nodule (1)
When considering the symptomatology associated with a thyroid nodule then the onset and rate of progression of symptoms are important in terms of risk of thyroid cancer
Assessment of symptomatology associated with a thyroid nodule:
Possible symptoms related to thyroid nodules include:
Swallowing complaints are common but non-specific
Laboratory testing
TFTs - to rule out hyperthyroidism
Calcitonin
Assessment of thyroid cancer risk
Need for thyroid biopsy based on clinical, laboratory, and ultrasound findings
The British Thyroid Association categories based on presence of different ultrasound features (composition, vascularity, echogenicity, shape, calcifications, lymph nodes, margins):
U1- normal | Do not need biopsy, unless patient has statistically high risk of malignancy |
U2 - benign | Do not need biopsy, unless patient has statistically high risk of malignancy |
U3 - indeterminate/equivocal | Thyroid biopsy recommended |
U4 - suspicious | Thyroid biopsy recommended |
U4 - malignant | Thyroid biopsy recommended |
If biopsy undertaken then next management step (whether surgical intervention or observation) based on
Reference:
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