How to Diagnose Thyroid Nodules and Thyroid Cancer

Thyroid nodules commonly occur in the population and are more frequent in women than in men by a ratio of about 4 to 1, and increase in frequency with age and with decreasing iodine intake. The prevalence of visible nodules is only approximately 4–7%, but the prevalence of ultrasound-detectable ones is between 19 and 67%. Nodules are also more common in patients who have suffered head and neck irradiation in the past. The goal of thyroid nodule evaluation and diagnosis is to identify and surgically treat patients with malignancies and avoid surgery in those with benign, asymptomatic ones. Here is a list of the techniques used for nodule diagnosis-

    • Physical examination- A detailed physical exam is done, with particular attention to voice quality, nodule characteristics and the adjacent nodal attachments. Hoarseness of voice is an indication of laryngeal nerve invasion caused by thyroid cancer. Nodule firmness is not particularly reliable but fixation of the nodule to adjacent or overlying structures substantially increases the probability of cancer. Deficits in neurologic function should be carefully sought and documented, and characteristics of syndromic endocrine diseases should be evaluated.


    • Laboratory evaluation- The initial laboratory tests may include measurement of thyroid hormone (thyroxine, or T4) and thyroid-stimulating hormone (TSH) in your blood to determine whether your thyroid is functioning normally. Apart from the highly sensitive TSH assay, anti–TSH-receptor antibody (TRAb) serum levels should be measured, which is required for affirmation of thyroid dysfunction. Initial diagnosis of nodules can also involve routine measurement of serum calcitonin level.


    • How to Diagnose Thyroid Nodules and Thyroid CancerThyroid imaging- Thyroid ultrasound is a key tool for nodule evaluation. It uses high-frequency sound waves to obtain a thyroid image. As an accurate and painless test it can ascertain if a nodule is solid or fluid filled (cystic) and also determine the exact nodule size. Ultrasound can help identify suspicious nodules and also those that are too small to feel during a physical examination. It can also be used to accurately guide a needle directly into a nodule when your doctor thinks a fine needle biopsy is needed. Once the initial evaluation is completed, it can be used to keep an eye on thyroid nodules that do not require surgery to determine if they are growing or shrinking over time.


    • Cytological diagnosis- Fine needle aspiration (FNA) biopsy may sound frightening, but the needle used is very small and a local anaesthetic may not even be necessary. This simple procedure is often done in the doctor’s office and should be performed for all patients depending on nodule size, appearance on ultrasound, and patient risk factors for thyroid cancer. The report of a thyroid fine needle biopsy will usually indicate one of the following findings:
      • The nodule is benign (noncancerous).
      • The nodule is malignant (cancerous) or suspicious for malignancy
      • The nodule is indeterminate
      • The biopsy may also be non-diagnostic or inadequate.


    • Thyroid scan- Nuclear scanning of the thyroid was frequently done in the past to evaluate nodules. However, use of thyroid ultrasound and biopsy has proven so accurate and sensitive, nuclear scanning is no longer considered a first-line method of evaluation. Nuclear scanning still has an important role in the diagnosis of rare nodules that cause hyperthyroidism.


Thyroid nodule is a common clinical presentation and it is vital to have clear diagnostic framework to ensure appropriate treatment of patients.

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