Thyroid Nodules - Workup and Testing
Is it malignant? ↑Risk: pt h/o irradiation to head/neck, +family hx, or h/o thyroid cancer syndromes (i.e. MEN 2)
Workup: obtain ultrasound and check TSH (low TSH=less likely CA, high TSH=more likely CA)
• Low TSH - measure FT4 and FT3, obtain Thyroid radionuclide (123I) scan.
o If “hot nodule,” consider Tx for hyperthyroidism if symptomatic. No biopsy necessary.
o If “cold nodule,” refer for US-guided FNA
• If normal or high TSH, measure FT4 and TPO antibody, refer for thyroid U/S and FNA based on US findings.
FNA: All nodules >2cm or >1cm with moderately suspicious qualities. No FNA for purely cystic nodules.
Follow up: Based on U/S characteristics. If neg FNA but highly suspicious U/S findings, repeat US/FNA within 12 mo. If low-moderate suspicious U/S findings, repeat U/S 12-24 mo, consider FNA if change. Can stop f/u after 2 neg FNAs.
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