Thyroid nodule

Question 1

What is the definition of a thyroid nodule?

Answer 1

Small lump(s) in the thyroid

Question 2

How common are thyroid nodules?

Answer 2

One in 12-15 woman have a thyroid nodule

Question 3

What is the pathophysiology of thyroid nodules?

Answer 3

• Single/solitary: mostly benign. Hot = too much T3/T4 being produced
• Multiple/multinodular: rare to find cancer unless growing rapidly
• Colloid and hyperplastic nodules: benign lumps which are either solitary/multinodular
• Thyroid adenoma: benign
• Thyroid cyst: fluid containing swelling
• Thyroid cancer: rare

Question 4

What are the signs/symptoms of thyroid nodules?

Answer 4

• Asymptomatic
• Pain
• When swallowing does the lump move? – thyroid lumps and thyroglossal cysts move upwards on swallowing
• Protruding tongue – thyroglossal cyst moves up
• Difficulty swallowing – RED FLAG
• Hoarseness of voice - REDFLAG
• Enlarged lymph nodes - REDFLAG

Question 5

What investigations are carried our for thyroid nodules?

Answer 5

• TFTs
• Thyroid US +/- biopsy or fine needle aspiration
• X ray
• Nuclear medicine scan – to check if hot/cold
• Basal plasma calcitonin and cardinoembryonic antigen – if thyroid cancer is suspected

Question 6

What are the surgical treatments for thyroid nodules?

Answer 6

• Partial/full thyroidectomy

Question 7

What are the pharmacological treatments for thyroid nodules?

Answer 7

• Levothyroixine
• Radioactive iodine
• Iodine replacement

Question 8

What are the non pharmacological treatments for thyroid nodules?

Answer 8

• No symptoms/cancer = no treatment

Question 9

What are the risk factors/aetiology of thyroid nodules?

Answer 9

• Woman
• Cyst
• Adenoma
• Cancerous tumour: higher risk <20 and >70
• Smoking
• Exposure to radiation