Discussion Author(s): Stephanie Bernard
Nodules are a common occurance in the thyroid gland, increasing in prevelance with age. Approximately 1:15 females and 1:40 males over the age of 40 have thyroid nodules. Even when solitary, 90-95% of all thyroid nodules are benign, representing cysts or adenomas. Features that increase concern that a nodule may represent a malignancy include patient age of less than 20 y/o or greater than 70 y/o, male, prior neck irradiation, history of thyroid cancer and development of lymphadenopathy, hoarseness or swallowing difficulties. On ultrasound, the findings of heterogenous complexity or solid lesion is more common although no specific feature indicates benignity or malignancy. By nuclear medicine thyroid scan, non-functioning (or cold) nodules carry a greater risk of malignancy but this is on the order of 12-15%. Ultimately, the method of distinguishing benign from malignant thyroid nodules lies in tissue evaluation, with fine needle aspiration (FNA) being very effective, of low morbidity and easily done in an outpatient setting. While approximately 5-10% of FNA yield a non-diagnostic specimen on first attempt, a tissue diagnosis is obtained in an additional 50% of these during a second visit.
Upto 80% of all malignancies of the thyroid are papillary carcinoma. The which has a 20-year survival rate of 98% for low-risk patients and 50% for high-risk patients. Treatment involves total thyroidectomy with 50+% of specimens demonstrating a multifocality of disease on pathologic evaluation. Further Iodine-131 ablation of residual thyroid tissue reduces the local recurrance rate to less than 5% and allows for thyroglobulin serum measurement as a means for surveillance for recurrance.
This patient was a 43 y/o male with the history of an mass in the thyroid region x 3 months. He underwent an FNA with well differentiated papillary thyroid carcinoma diagnosed.
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