Thursday, 4 August 2011

Thyroid Nodules

Thyroid nodules (lumps) are very common.

Approximately 50% of people will have a thyroid lump if the thyroid is scanned with an ultrasound machine

In the UK the only lumps that need to be assessed are:

1. Visible thyroid swellings
2. Palpable thyroid swellings
3. Thyroid nodules seen on scans >1cm in size

Thyroid nodules under 1cm in size do not require any action

In my view thyroid ultrasound is over used particularly outside hospitals and I generally recommend that patients should first see someone in a one-stop thyroid clinic where biopsies are undertaken after clinical assessment.

The only way to determine whether a thyroid nodule is benign or malignant is to perform a fine needle aspiration of some cells which are then assessed under a microscope by a cytology specialist.

The Fine Needle Aspiration (FNA) can either be done by the consultant in clinic - quick and straightforward using a blood test needle - or done by a radiology specialist with the aid of ultrasound.

The results from FNA are classified:

THY 1           Not enough cells to give a clear diagnosis - the test must be repeated to acheive a diagnosis

THY 2           Benign - repeated at 2-3 months as a second double check and if still benign

THY 3           Indeterminate - this should be reviewed in a thyroid multi-disciplinary team meeting

THY 4           Suspicious result which may represent a thyroid cancer

THY 5           Definite thyroid cancer according to cytology

The action following the biopsy is outlined below:

THY 1           Repeat to establish diagnosis if possible - if no clear answer needs surgery to remove

THY 2           Benign and can therefore safely leave alone or offer patient choice re excision

THY 3           Remove to acheive definite diagnosis as 20% plus are cancerous

THY 4           Repeat to acheive definite diagnosis if possible or remove with on-table frozen section

THY 5          Needs surgery - usually a total thyroidectomy

Benign nodules are still removed.  The reasons for removing these are:

1. Symptoms - often uncomfortable in the neck, difficulty swallowing, choking feeling etc

2. Cosmetic issues

3. Cancer concerns

4. Family history of thyroid cancer

5. Radiation exposure - particularly as a child (increase cancer risk) - Thyroid surgery by a UK specialist surgeon

Thyroid Surgery by a UK specialist surgeon

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