Clinical Case Database / Category: Clinical Care

Investigation of the thyroid nodule

Publication details

Mahdi Khalfaoui, F1, Shazli Azmi, ST3, Edward Jude
Foundation Years Journal, volume 4, issue 9, p.10 (123Doc Education, London, December 2010)


Thyroid nodules are a common finding. These present as palpable nodules, or as an incidental finding through imaging for other reasons. Of all thyroid nodules found, as few as 5% represent a thyroid cancer. Traditionally the evaluation of a thyroid nodule commences with a thorough history and focused examination. This is followed by routine measurement of the thyroid hormones (T3 & T4) and Thyroid stimulating hormone (TSH). This immediately determines whether the nodule is causing a hormonal disturbance, which can give clues to its cancerous potential. Nodules resulting in hyperthyroidism should undergo radionuclide scanning which can support the diagnosis of a benign thyroid nodule if shown to be "hot". Ultrasound can confirm the presence of a nodule and in experienced hands identify features suggestive of malignancy. Ultrasonography is unable to definitively refute the presence of thyroid malignancy, rendering fine needle aspiration (FNA) biopsy the most accurate method for evaluating a nodule. A FNA biopsy is however an invasive method for evaluating nodules and following this procedure, the cytology results are not always clear-cut. Cytology results including "non-diagnostic" and "suspicious" often present clinicians with challenging dilemmas with regard to further investigation. Options include a further FNA biopsy, with studies supporting the use of ultrasound guidance in accurately identifying suspicious areas of the gland. Ultimately removal of the gland through surgery will determine its histology and eliminate any risk of malignancy posed by the gland.

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Mahdi Khalfaoui, F1

Tameside Hospital NHS Foundation Trust,

Shazli Azmi, ST3

Tameside Hospital NHS Foundation Trust

Edward Jude

Consultant Diabetologist and Senior Lecturer
Tameside Hospital NHS Foundation Trust


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