Saturday, June 11, 2016

Step 2 CK: Investigating thyroid nodule


If you find a thyroid nodule on clinical examination, the next best step is to get a TSH level.

Why? Because it helps you decide which investigation to order next!

If TSH is low, you need to do a radionucleotide scan first.

Why? Because it helps you decide whether or not you need a fine needle aspiration cytology (FNAC)

If the nodule is functioning, do not do a FNA. It just means hyperthyroidism. Observe or treat depending of FT4, T3 levels.

If the nodule is non functional, however, you must do a FNAC for a possible malignancy.

If TSH is normal or elevated, it means there could be something suspicious in the glad, do FNAC of the nodule.

Why not do a scan? Because the nodule will likely be non functional and will tell you nothing else to change your management,

UpToDate mentions sonographic criteria for biopsy before jumping to a FNA, but Master The Boards says that USG can never exclude malignancy and you must always do a FNAC.

 Investigating thyroid nodule
That's all!

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