Treatment of thyroid nodules

1
Treatment of thyroid nodules

• Depends on
• FNA cytological examination
• Uptake of radioiodine
• Size and patient preferences

2
Thyroid cancer conundra

• Thyroid nodules are common - gt50 over 50y
• Histological appearances of cancer are present in
  5-25 of thyroids at autopsy
• Clinical thyroid cancer is rare 30 per 106 p.a.
  and death rates low (6 per 106 p.a.)

3
Thyroid cancer
TNM Grading T primary tumor T0 no palpable
tumor T1 single tumor confined to the gland
T2 multiple tumors confined to the gland T3
tumor extending beyond the gland N regional
lymph nodes N0 no palpable nodes N1
moveable nodes on one side N2 moveable
bilateral nodes N3 fixed nodes M distant
metastases M0 none M1 distant
metastases Clinically, the dominant factor in
governing prognosis in thyroid epithelial cell
cancer is age. Others factors include size of
primary tumor, degree of invasiveness,
histological grade and the presence of
metastases. Of these, all except histological
grade are incorporated into the TNM
classification.
4
Treatment of thyroid cancer

• Extent of surgery and radioiodine depends on
• Prognosis (i.e. TNM, age, histological grade)
• Concentrating ability for 131I
• Preferences of both patient and medical staff
• General agreement that TSH should be suppressed
• Follow up by serum thyroglobulin measurement
  123I scans