Thyroid Nodule

Ambulatory Morning Report

Margarita Barreiro M.D
• Evaluation of thyroid nodules
• Different clinical scenarios
 Case
• 33 year old female with no significant PMH
who presents to the clinic because she noticed
a lump on her neck
• No dysphagia, hoarseness, no systemic
symptoms
• Fmx of thyroid ca-mother
• Next step?
• When do we do a work
up?
• Why do we care about
imaging?

• Bottomline:
• Cancer vs. No Cancer
 Red flags
• Rapid growth of neck mass
• Hx head and neck irradiation
• Total body irradiation from bone marrow
transplant
• Fam hx of thyroid cancer
Thyroid Ultrasound
• Solid hypoechoic nodule in the mid to lower
pole of the left lobe anteriorly measures
3.2x1.3x2.4cm
 Suspicious Ultrasound Findings
• Hypoechoic
• Microcalcifications
• Twinkling on B flow imaging
• Central Vascularity
• Irregular margins
• Incomplete halo
• Nodule taller than wider
• Documented enlargement of nodule
 Sonographic findings needing biopsy
regardless of size
• Subcapsular location adjacent to recurrent
laryngeal nerve
• Extrathyroid extension
• Extrusion through rim calcifications
• Abnormal cervical lymphadenopathy
 Nodule >1cm +
• Irregular margins
• Microcalcificaitons
• Taller than wider
• Rim calcifications
TSH normal or high
TSH normal or
high

Meets criteria for Does not meet

FNA criteria FNA

Susipcious: Q6-12
FNA
mos

Intermediate:
Q12-24 mos

Very low risk: Q2-

3 yrs
 33F with ultrasound findings as
follows. What is the next step?
• hypoechoic nodule 2x2cm with calcification
• 2cm cystic nodule with no solid component