Adenoma Thyroid

Fanny Indarto
 Goiter
• Goiter : thyroid enlargement
• refers to enlargement resulting from a variety
of benign conditions:
– physiological (puberty,pregnancy),
– metabolic (dietary iodine deficiency, i.e., endemic
goiter),
– abnormal iodine metabolism, or
– inflammatory/ autoimmune diseases (Hashimoto’s
disease,Graves’ disease).
Endocrine Surgery,2004
Thyroid Nodule

Sabiston,2017
Schwartz's Principles of Surgery, 2010
 Adenoma
• Prolonged thyroid enlargement results in the
formation of multiple adenomatous nodules,
which may undergo hemorrhageand fibrosis,
leading to a multinodular (adenomatous)
goiter.
 Adenoma Types
• Folicular Adenoma
• Hu¨ rthle Cell Adenoma
• Atypical Adenoma?
• Hyalinizing Trabecular Tumor
 Folicular Adenoma
• The most common solitary thyroid mass is an
adenoma.
• These are encapsulated, benign, expansions of
thyroid follicles, compressing adjacent thyroid
parenchyma.
• On gross inspection, the capsule is usually thin
and flimsy; a thickened capsule can raise the
diagnostic possibility of a ‘‘minimally invasive
follicular carcinoma’’
• Once a thyroid nodule is detected by physical
examination, a TSH level is obtained and UG-
FNA performed.
• If the TSH is depressed, radioiodine scanning
and uptake is undertaken to determine
whether there are one or more nodules with
autonomous function or one or more
nonfunctioning nodules with internodular
thyroiditi
• Surgery is also appropriate for patients when the thyroid
nodule is:
(1) symptomatic (dyspnea, dysphagia,or venous
compression), enlarging, or at risk of becoming symptomatic,
(2) autonomous,and radioactive iodine therapy is refused
(3) cosmetically a problem
(4) suspicious or diagnostic for a malignancy
(5) none or the above,but the patient cannot tolerate the
uncertainty of whether the nodule could represent a
malignancy,
• If the TSH is normal or elevated, radioiodine
scanning is not necessary.
• Thyroid hormone replacement therapy is
started if the patient is hypothyroid.
• Observation is indicated for asymptomatic,
nonfunctioning thyroid nodules with benign
cytology or if the cytology is
indeterminate/nondiagnostic and the patient is
at low risk for thyroid cancer.
 Toxic multinodular goiters
• usually occur in older individuals, who often have a prior
history of a nontoxic multinodular goiter. Over several
years, enough thyroid nodules become autonomous to
cause hyperthyroidism
• Hyperthyroidism also can be precipitated by iodide-
containing drugs such as contrast media and the
antiarrhythmic agent amiodarone
• Hyperthyroidism must be adequately controlled. Surgical
resection is the preferred treatment of patients with toxic
multinodular goiter with subtotal thyroidectomy being the
standard procedure.

Schwartz, 2010
 Toxic Adenoma (Plummer's Disease)

• Hyperthyroidism from a single hyperfunctioning nodule typically

occurs in younger patients who note recent growth of a long-
standing nodule along with the symptoms of hyperthyroidism.
• Most hyperfunctioning or autonomous thyroid nodules have
attained a size of at least 3 cm before hyperthyroidism occurs.
Physical examination usually reveals a solitary thyroid nodule
without palpable thyroid tissue on the contralateral side. RAI
scanning shows a "hot" nodule with suppression the rest of the
thyroid gland. These nodules are rarely malignant.
• Smaller nodules may be managed with antithyroid medications
and RAI. Surgery (lobectomy and isthmusectomy) is preferred to
treat young patients and those with larger nodules.

Schwartz, 2010
 Incidence
• Most true intrathyroidal nodules will
represent colloid adenomas (27–60%) or
simple follicular adenomas (26–40%).
• About 5% of thyroid nodules are classified as
hyperfunctioning and are “hot” on
radionuclide scanning based on a relative
increased ability to trap iodide.

Thyroid Cancer, Wartosky, 2006

USG
• “Hot” or “hyperfunctioning” nodules indicate
significant increased radioiodine uptake relative
to normal thyroid tissue, with or without
suppression of the remaining thyroid tissue.
• Sometimes “warm” has also been used to
describe the latter, which again is an area on
the scan that has slightly increased radioiodine
uptake in association with adjacent normal
thyroid tissue.
Pathophysiology of Diseases, 1997
• If the cytologic diagnosis indicates a benign nodule, there are three
options for the clinician. These include surgery, observation and
hormone suppression.
• If the nodule is causing symptoms, or is aesthetically displeasing to
the patient, surgery may be considered. Surgery should also be
considered in those patients who are at increased risk for thyroid
cancer despite a benign FNA.
• If the patient does not require surgery, the nodule may either be
observed or suppressed with Levothyroxine. The goal of thyroid
hormone administration is to eliminate TSH stimulation by total
exogenous replacement of the body’s need for thyroid hormone. This
should either reduce the size of the nodule or prevent its further
growth.

Endocrine Surgery,Vademecum, 2000