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Old 05-09-2014
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Default Thyroid nodule management

THYROID NODULES
Majority of the thyroid nodules are discovered incidentally during physical exam.
Management of thyroid nodule is as follow:
Initial step is to check TSH Level and further management is as follow:
  • If TSH is low, then get a radionuclide uptake scan (RAUI)
1a. If a radionuclide scan shows hot nodule (increased uptake), then treat the patient with PTU
1b. If a radionuclide scan shows cold nodule (decreased uptake), then do ultrasound-guided fine-needle aspiration (FNA) (discussed below)

  • If TSH is normal or high, then management is as follow:
2a. Nodule ≤ 1cm and patient has no risk factors for thyroid cancer, then do regular follow-up. However, if patient has risk factors for thyroid cancer, then do FNA (discussed below)
2b. Nodule > 1cm, then do FNA (discussed below)

FNA results and treatment options:
  • If FNA shows malignancy, then do surgery or radioiodine ablation
  • If FNA shows benign cytology, then treat the patient with levothyroxine and follow-up. If tumor is regressing, then continue the treatment. However, it tumor is still the same, then repeat the FNA or surgical excision
  • IF FNA shows non-functioning or cold nodule, then repeat RAUI, if scan shows increased uptake, then treat the patient with PTU. However, if scan shows decreased uptake, then do surgery or radioiodine ablation
look for the book check it online: Most Likely Diagnosis USMLE Step 2 CK

By Dr. Dhesi
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