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AccessSurgery's Quick Test lets you test your surgical knowledge and anonymously compare your results to those of your peers. Sign up for our free AccessSurgery e-newsletter and twice a month Quick Test will appear in your email inbox. Quick Test is developed by Gerard M. Doherty, MD, AccessSurgery's Editor-in-Chief, from the site's online resources. Your results will be ranked against those of your peers.
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Quick Test posted on 10.25.11:
| Thyroid Nodules
| The problems facing the clinician when confronted by a patient with a nodular goiter or thyroid nodule are whether the lesion is symptomatic and whether it is benign or malignant. The differential diagnosis includes benign goiter, intrathyroidal cysts, thyroiditis, benign and malignant tumors, and metastatic tumors to the thyroid. The history should specifically emphasize the duration of swelling, recent growth, local symptoms (dysphagia, pain, or voice changes), and systemic symptoms (hyperthyroidism, hypothyroidism, or those from possible tumors metastatic to the thyroid). The patient's age, sex, place of birth, family history, and history of radiation to the neck are most important. Low-dose therapeutic radiation (6.5?2000 cGy) in infancy or childhood is associated with an increased incidence of thyroid cancer (about 10%) in later life. A thyroid nodule is more likely to be a cancer in a man than in a woman and in young (under 20 years) and older (over 60 years) patients rather than in others. In certain geographic areas, endemic goiter is common, making benign nodules more common. Thyroid cancer is familial in about 25% of patients with medullary thyroid cancer (familial medullary thyroid cancer, MEN 2a and 2b) and in about 7% of patients with papillary cancer or Hürthle cell cancer. Papillary thyroid cancer occurs more often in patients with Cowden's syndrome, Gardner's syndrome, or Carney's syndrome.
The clinician must systematically palpate the thyroid to determine whether there is a solitary thyroid nodule or if it is a multinodular gland and whether there are palpable lymph nodes. A solitary hard thyroid nodule is likely to be malignant, whereas most multinodular goiters are benign.
In many patients, the possibility of cancer is difficult to exclude without microscopic examination of the gland itself. Percutaneous needle biopsy is the most cost-effective diagnostic test for most patients and has replaced radioiodine scanning.
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