Evaluation of a Thyroid Nodule

Posted by e-Medical PPT Tuesday, August 21, 2012
Epidemiology – Thyroid Nodule
Nodules common, whereas cancer relatively uncommon
Goal is to minimize “unnecessary” surgery but not miss any cancer
It increases with age.
Higher in women
Estimated 5-15% of nodules are cancerous
Although cancer more common in women, a nodule in a man is more likely to be cancer

Epidemiology – Pregnancy
Pregnancy increases risk
One study: u/s detection nodules –
    9.4% nulliparous women
    25% women previously pregnant
Attributed to increased renal iodide excretion and basal metabolic rate
Rosen: Nodules presenting during pregnancy – 30 patients, 43% were cancer
 HCG may be growth promoter (TSH-like activity)

Epidemiology – Radiation
Appears to be dose-dependent
ERR 7.7 at 100 cGy
Maximum risk approximately 30 years later
Nodule in radiated patient: 35-40% cancer
Data suggest no more aggressive behavior over spontaneously-occurring cancers, but may be larger at presentation
Only unequivocal environmental cause of thyroid cancer

Epidemiology – Children
Nodule more likely to be cancer than adults
10% thyroid cancer age <21
Thyroid ca 1.5-2.0% all pediatric malignancies
More likely to present with neck metastasis
Most common cause thyroid enlargement is chronic lymphocytic thyroiditis

Medullary Thyroid Carcinoma
FMTC, MEN 2A, MEN 2B
RET proto-oncogene (chromosome 10)
Calcium / Pentagastrin stimulation
Prophylactic thyroidectomy recommended age 2-6
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