Approach to a Thyroid Nodule - causes, investigation and treatment

hello in this video we're gonna talk about thyroid nodules a thyroid nodule is technically a goiter which means an enlarged thyroid gland a thyroid nodule can be defined as a nodule goiter thyroid nodule is usually identified by the patient on routine examination or incidentally on imaging such as a CT neck or CT chest when someone notices a lump on their neck or third I guess one of the most concerning things is could this be cancer majority of thyroid nodules are benign thyroid cancer make up about 5% of the cases and there are factors that increases the suspicion of cancer such as if the thyroid nodule is in children young adults a person with a history of radiation to the neck or head and also someone who has a family history of thyroid cancer a thyroid nodule is actually very common 50% of the population habit but only 10% can actually be felt like all thyroid diseases it is more common in women and the incident increases with age majority of thyroid nodules as we discussed are benign 95% of cases some common examples of benign thyroid nodules are thyroid adenoma which can be a basic a 9 folliculitis no mo the most common cause of a solitary thyroid nodule of course this adenoma can undergo mutation in its thyroid stimulating hormone receptor and can progress to become a toxic adenoma which is also benign and toxic adenoma is where the adenoma becomes hyper functioning and produces a lot of t3 and t4 irrespective of thyroid stimulating hormone another cause of thyroid nodule is toxic multinodular goiter as the name suggests toxic here again the thyroid nodules have autonomous production of t3 and t4 it's producing a lot of t3 and t4 irrespective of thyroid stimulating hormone a thyroid cyst is another cause of thyroid nodule and essentially as a fluid sac another cause of thyroid nodule is Hashimoto's thyroiditis which is an autoimmune disease characterized by anti bodies against a thyroid peroxidase and a thyroid gland resulting in thyroid damage this inflammation and damage to the thyroid causes the nodules to form 5% of thyroid nodules are cancerous and there are many types of thyroid cancer which we will not talk about but the most common thyroid cancer is papillary thyroid cancer there are features of the thyroid nodule which may sway one to think that it is cancerous and this includes being a non-functional thyroid nodule meaning the thyroid nodule doesn't produce any thyroid hormones another feature of the thyroid nodule can be that if it's an irregularly shaped thyroid nodule this also may suggest cancer there are a number of investigations that can be ordered for people with thyroid nodules these include thyroid stimulating hormone levels in the blood fired ultrasound a radionucleotide scan also known as a thyroid scan or thyroid scintigraphy there's so many names for a blood test looking at free t3 and t4 and for a definitive diagnosis a fine needle aspiration of the thyroid nodule with an ultrasound because thyroid nodules are so common not everyone gets a fine needle aspiration and there are only specific indications for it in the next part of this video we will follow an approach to someone who presents with a thyroid nodule this approach can also be used with someone who has a diffuse Khoi - as well so we begin with the identification of the thyroid nodule through history and of course examination looking at the brain the hypothalamus produces thyrotropin-releasing hormone grh which targets the anterior pituitary gland to release thyroid stimulating hormone TSH this third stimulating hormone will then of course target a thyroid gland to produce t3 and t4 the first thing to order with anyone with a thyroid nodule or a thyroid pathology is thyroid stimulating hormone levels and a plus - ultrasound of the thyroid gland if the third steam adding hormone level is high or normal an ultrasound should be ordered high thyroid stimulating hormone should raise suspicion of hypothyroidism the ultrasound helps assess the anatomy of the thyroid gland and the nodule and its adjacent structures it provides more anatomical detail than a thyroid nucleotide scan the thyroid ultrasound can help identify any suspicious features of cancer suspicious ultrasound findings include a nodule greater than one centimeter solid and hypoechoic a nodule that is large or rapidly growing a nodule with micro calcification and nodule with central vascularity a nodule that is taller than it is wider after the ultrasound is done the next question to ask is does this thyroid nodule meet the criteria for a fine needle aspiration the criteria for a final aspiration includes those suspicious findings we just talked about on ultrasound so if yes there is suspicious findings on the ultrasound then a fine needle aspiration should be performed if there is no suspicious findings and the thyroid nodule does not meet the fine needle aspiration criteria then we just monitor the nodule and may repeat a thyroid ultrasound in a few months time focusing now on fine needle aspiration it is essentially where you use a needle and aspirate the content of the thyroid nodule with the help of the ultrasound the aspiration is sent to the laboratory for psychology to see the cells in more detail the fine needle aspiration results are then classified into what's called the best fez de clases of which there are six class 1 is a non diagnostic result which means that probably insufficient samples were taken in this scenario it is advised to repeat the fine idle aspiration plus 2 is benign adenoma class 3 is a tibia of undetermined significance or follicular of undetermined significance in this scenario it is important to monitor the nodule for classes 4 5 and 6 which are follicular neoplasia suspicious for malignancy and malignancy a thyroidectomy is advised a thyroidectomy can be partial or complete which basically means removal of part or all of the thyroid gland now to recap we came down the pathway where there was initially normal or high TSH levels important that people with high TSH high thyroid stimulating hormones these guys should also be screened for causes of hypothyroidism such as Hashimoto's disease if indicated now let us follow the algorithm when there is low TSH low TSH which is low thyroid stimulating hormone levels should ring alarm bells for hyperthyroidism because remember high t3 at high T for will have a negative feedback to reduce TSH release when someone has low TSH the next investigation should be a thyroid scintigraphy a thyroid Centegra fees also known again as a thyroid radionucleotide scan and also known as a thyroid scan iodine is an important component of thyroid hormones a thyroid scintigraphy is where a chemical tag molecule such as iodine is given iodine is taken up by the thyroid gland normally if the thyroid nodule does not take up any iodine it is non-functional and means it does not synthesize or produce any thyroid hormones the other side is an autonomous nodule where the nodule is taking up iodine to produce thyroid hormone when a nodule has uptake of eye on the thyroid scan it is called a hot nodule and it is rarely cancerous a cold non-functioning nodule on the other hand raises suspicions of thyroid cancer and should have an ultrasound with consideration of a fine needle aspiration for a definitive diagnosis a hot autonomous nodule can either be taking up way too much iodine than the rest of the thyroid gland or it is taking up iodine at the same concentration or level as the rest of the thyroid gland to be exactly short it is advised that 3 t3 and t4 be measured a normal t3 and t4 with low TSH is a clinical diagnosis of subclinical hyperthyroidism subclinical hyperthyroidism will require monitoring because subclinical hyperthyroidism can can evolve and become hyperthyroidism a high t3 and t4 with low TSH means hyperthyroidism the nodule is responsible for producing excess t3 and t4 and because this is a nodule and it's taking up a lot of iodine on the scan it is likely to be a toxic adenoma toxic adenoma is either managed by surgery a thyroidectomy or by radioactive iodine in this treatment radioactive iodine is given which will be mostly taking taken up by the hyperactive autonomous nodule the radioactive iodine will break down emitting radioactive waves destroying the tissue thus hopefully shrinking the thyroid nodule or making it less functional so we just looked at an approach to a thyroid nodule and this same approach can be used for someone with a diffuse Reuter I hope this video was helpful thank you for watching you

Channel: Armando Hasudungan

Views: 110,157

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Keywords: thyroid nodules, neck lump, causes of neck lump, thyroid cancer, thyroid nodule biopsy, lump on side of neck, thyroid mass, causes of thyroid nodule, what is goiter, goiter of neck, thyroidectomy, what is the thyroid gland, thyroid gland nodule, thyroid gland anatomy and physiology, physiology of the thyroid gland, nodular goiter, diffuse and nodular goiter, thyroid nodule investigation, thyroid ultrasound

Id: BM2u1PcdOuA

Length: 10min 48sec (648 seconds)

Published: Sat Sep 14 2019