Approach to thyroid nodules

Abstract

Nodular thyroid disease is a common endocrinopathy that prevalence varies according to the iodine uptake. Nodular goiter becomes more prevalent in both gender as the age increases. When patient with a thyroid nodule is seen compression symptoms, thyroid function and malign benign separation are the first investigations that should be performed. The next step should be the evaluation of the nodule to decide whether surgery or medical treatment is required. After clinical evaluation of a patient with a thyroid nodule, serum TSH measurement and ultrasonographic evaluation are the first investigations that should be performed. Cytological examination of fine needle aspiration biopsy (FNAB) specimens has been proved to be the most efficient and specific method of diagnosing thyroid cancer preoperatively.

Keywords

• Nodular goiter
• Thyroid nodule
• Fine-needle aspiration biopsy
• Iodine
• Thyroid neoplasm
• Goiter

Tiroit nodüllerine yaklaşım

Abstract

Nodüler tiroit hastalığı sık görülen endokrinolojik bir hastalık olup prevalansı iyot alımına göre önemli ölçüde değişmektedir. Her iki cinsiyette de yaş ile birlikte nodüler guatr prevalansında artış saptanmıştır. Tiroit nodülü ile karşılaşıldığında ilk yapılması gereken malign-benign ayırımı, sonrasında kompresyon belirtileri, tiroit fonksiyonlarının değerlendirilmesi ve cerrahi gereken nodül ile medikal tedavi gereken nodül ayırımını yapmak olmalıdır. Klinik değerlendirme sonrasındaki ilk değerlendirme serum TSH ölçümü ve ultrasonografik inceleme olmalıdır. Preopeartif olarak tiroit kanserinin teşhisinde Tiroit ince iğne aspirasyon biyopsisi sitolojik incelemesinin en etkili ve spesifik metod olduğu ispatlanmıştır.

Keywords

• Nodüler guatr
• Tiroit nodülü
• İnce iğne aspirasyon biyopsisi
• Tiroit kanserleri
• İyot
• Guatr

References

1. Alexander, E.K., Hurwitz, S., Heering, J.P., Benson, C.B., Frates, M.C., Doubilet, P.M., Cibas, E.S., Larsen, P.R., Marqusee, E., 2003. Natural history of benign solid and cystic thyroid nodules. Ann. Intern. Med. 138, 315-318.
2. Baloch, Z.W., LiVolsi, V.A., Asa, S.L., Rosai, J., Merino, M.J., Randolph, G., Vielh, P., DeMay, R.M., Sidawy, M.K., Frable, W.J., 2008. Diag- nostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: A synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagn. Cytopathol. 36, 425-437.
3. Boelaert, K., Horacek, J., Holder, R.L., Watkinson, J.C., Sheppard, M.C., Franklyn, J.A., 2006. Serum thyrotropin concentration as a novel pre- dictor of malignancy in thyroid nodules investigated by fine-needle aspiration. J. Clin. Endocr. Metab. 91, 4295-4301.
4. Carmeci, C., Jeffrey, R.B., McDougall, I.R., Nowels, K.W., Weigel, R.J., 1998. Ultrasound-guided fine-needle aspiration biopsy of thyroid masses. Thyroid. 8, 283-289.
5. Cibas, E.S., Ali, S.Z., NCI Thyroid FNA State of the Science Conference, 2009. The bethesda system for reporting thyroid cytopathology. Am. J. Clin. Pathol. 132, 658-665.
6. Cooper, D.S., Doherty, G.M., Haugen, B.R., Hauger, B.R., Kloos, R.T., Lee, S.L., Mandel, S.J., Mazzaferri, E.L., McIver, B., Pacini, F., Schlum- berger, M., Sherman, S.I., Steward, D.L., Tuttle, R.M., 2009. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nod- ules and Differentiated Thyroid Cancer. 19, 167-214.
7. Danese, D., Sciacchitano, S., Farsetti, A., Andreoli, M., Pontecorvi, A., 1998. Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid. 8, 15-21.
8. Elisei, R., Bottici, V., Luchetti, F., Di Coscio, G., Romei, C., Grasso, L., Miccoli, P., Iacconi, P., Basolo, F., Pinchera, A., Pacini, F., 2004. Impact of routine measurement of serum calcitonin on the diagnosis and outcome of medullary thyroid cancer: Experience in 10,864 patients with nodular thyroid disorders. J. Clin. Endocr. Metab. 89, 163-168.

9. Erdoğan, G., Erdoğan, M.F., Emral, R., Baştemir, M., Sav, H., Haznedaroğlu, D., Üstündağ, M., Köse, R., Kamel, N., Genç, Y., 2002. Iodine status and goiter prevalence in Turkey before mandatory iodization. J. Endocrinol. Invest. 25, 224-228.
10. Franco, C., Martı´nez, V., Allamand, J.P., Medina, F., Glasinovic, A., Osorio, M., Schachter, D., 2009. Molecular markers in thyroid fine-needle aspiration biopsy: A prospective study. Appl. Immunohistochem. Mol. Morphol. 17, 211-215.
11. Frates, M.C., Benson, C.B., Doubilet, P.M., Kunreuther, E., Contreras, M., Cibas, E.S., Orcutt, J., Moore F.D. Jr., Larsen P.R., Marqusee, E., Alexander E.K., 2006. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J. Clin. Endocr. Metab. 91, 3411-3417.
12. Gharib, H., Goellner, J.R., Johnson, D.A., 1993. Fine-needle aspiration cytology of the thyroid. A 12-year experience with 11,000 biopsies. Clin. Lab. Med. 13, 699-709.
13. Hoving, J., Piers, D.A., Vermey, A., Oosterhuis, J.W., 1981. Carcinoma in hyperfunctioning thyroid nodule in recurrent hyperthyroidism. Eur. J. Nucl. Med. 6, 131-132.
14. Kim, W.B., Han, S.M., Kim, T.Y., Nam-Goong, I.S., Gong, G., Lee, H.K., Hong, S.J., Shong,Y.K., 2004. Ultrasonographic screening for detec- tion of thyroid cancer in patients with Graves' disease. Clin. Endocrinol. 60, 719-725.
15. Kuy, S., Roman, S.A., Desai, R., Sosa, J.A., 2009. Outcomes following thyroid and parathyroid surgery in pregnant women. Arch. Surg. 144, 399-406.
16. Layfield, L.J., Abrams, J., Cochand-Priollet, B., Evans, D., Gharib, H., Greenspan, F., Henry, M., LiVolsi, V., Merino, M., Michael, C.V., Wang, H., Wells S.A., 2008. Post thyroid FNA testing and treatment options: A synopsis of the National Cancer Institute Thyroid Fine Needle As- piration State of the Science Conference. Diagn. Cytopathol. 36, 442-448.
17. Moosa, M., Mazzaferri, E.L., 1997. Outcome of differentiated thyroid cancer diagnosed in pregnant women. J. Clin. Endocr. Metab. 82, 2862– 2866.
18. Nayar, R., Ivanovic, M., 2009. The indeterminate thyroid fine-needle aspiration: Experience from an academic center using terminology similar to that proposed in the National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Cancer. 117, 195-202.
19. Özata, M., 2005. Tiroid hastalıklarına güncel yaklaşım. Epsilon Yayıncılık, İstanbul. pp. 118.
20. Pacini, F., Pinchera, A., Giani, C., Grasso, L., Doveri, F., Baschieri, L., 1980. Serum thyroglobulin in thyroid carcinoma and other thyroid disorders. J. Endocrinol. Invest . 3, 283-292.
21. Ramos, C.D., Zantut-Wittmann, D.E., Tambascia, M.A., Assumpção, L., Etchebehere, E.C., Camargo, E.E., 2000. Thyroid suppression test with L-thyroxine and [99mTc]pertechnetate. Clin. Endocrinol. (Oxf). 52, 471-477.
22. Reiners, C., Wegscheider, K., Schicha, H., Theissen, P., Vaupel, R., Wrbitzky, R., Schumm-Draeger, P.M., 2004. Prevalence of thyroid disorders in the working population of Germany: Ultrasonography screening in 96,278 unselected employees. Thyroid. 14, 926-932.
23. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer, 2009. Thy- roid. 19, 1167-1214.
24. Schneider, A.B., Bekerman, C., Leland, J., Rosengarten, J., Hyun, H., Collins, B., Shore-Freedman, E., Gierlowski, T.C., 1997. Thyroid nodules in the follow-up of irradiated individuals: Comparison of thyroid ultrasound with scanning and palpation. J. Clin. Endocr. Metab. 82, 4020- 4027.
25. Takashima, S., Fukuda, H., Kobayashi, T., 1994. Thyroid nodules: Clinical effect of ultrasound-guided fine-needle aspiration biopsy. J. Clin. Ultrasound. 22, 535-542.
26. Tan, G.H., Gharib, H., 1997. Thyroid incidentalomas: Management approaches to nonpalpable nodules discovered incidentally on thyroid imag- ing. Ann. Intern. Med. 126, 226-231.
27. Yang, J., Schnadig, V., Logrono, R., Wasserman, P.G., 2007. Fine-needle aspiration of thyroid nodules: A study of 4703 patients with histologic and clinical correlations. Cancer. 111, 306-315.