Dubai Thyroid Clinic
At Dr Rami Hamed Center in DHCC we provide the leading thyroid specialist in dubai for complete care of thyroid diseases including all diagnostic modalities and latest non surgical and surgical techniques available for best outcomes
A discrete swelling in an otherwise impalpable gland is termed solitary thyroid nodule
- Prevalence: 3-5 % of adult population.
- Female:Male – 4:1
- Importance of STN lies in the risk of malignancy compared with other thyroid swellings.
- 10 –15% of STN are malignant.
Types of Solitary Thyroid Nodule (STN):
- Dominant nodule of a multinodular goitre
- Thyroid adenoma
- Thyroid cyst
- Thyroid carcinoma
- Localised form of thyroiditis, colloid goiter
Work up of a STN-History:
- Age and gender
- Children: Child with a thyroid nodule – 50% chance of it being malignant
- Men > 50yrs
- Exposure to radiation for Hodgkin’s/ Ca Breast
- 35 yrs after exposure
- 7-10% of exposed patients
- 100 Rads - Thyroid nodules/ Thyroid carcinoma
- >2000 Rads - Prevent thyroid neoplasm/ Thyroid gland destroyed
- Rapid nodule growth
- Pain, Hoarseness, Compressive symptoms
- History for specific endocrine disorders-medullary carcinoma, MEN type2
- Family h/o thyroid carcinoma
Evaluation of STN:
- Lab Evaluation:
- Thyroid function test (T3, T4, TSH) - To identify patients with unsuspected hyperthyroid states and dictate appropriate workup.
- Serum calcitonin level-Medullary carcinoma is strongly suspected.
- Detection of thyroid autoantibodies in patients with toxic features (anti microsomal and anti thyroglobulin antibodies).
- Nature of the swelling (Solid or cystic) – cystic lesions are usually but not always benign.
- To detect nodules of a MNG which are not clinically palpable.
- To detect lymph nodes.
- Follow up of patients who are managed conservatively to detect increased volume of a suspicious lesion.
- Thyroid scan:
- Using Iodine131 or Technetium-pertechnetate 99m.
- On scanning swellings are categorised as hot (overactive), warm (active) or cold (underactive)
- Not useful in distinguishing benign and malignant lesions since majority of cold nodules are benign (80%) and some warm nodules are malignant (5%)
- Only indication is in patients with toxic features to differentiate Toxic adenoma (rest of the gland is suppressed) from toxic MNG.
- Single most useful investigation which can detect most of the conditions.
- A specimen is considered adequate if at least six properly prepared smears contain 15-20 groups of well preserved clumps of follicular epithelium.
- Can diagnose colloid nodules, thyroiditis, papillary carcinoma, medullary carcinoma, anaplastic carcinoma and lymphoma.
- Cannot distinguish between a follicular adenoma and carcinoma.
- Follicular cells in FNAC, 6-20% chance of malignancy.
- Sensitivity – 89%
- Specificity - 91%
- False negative rate, 1- 6%. Hence benign nodules diagnosed by FNAC should be followed sequentially with ultrasound to make sure the characteristics do not change.
- FNAC results – benign, suspicious or malignant.
- Suspicious lesions increased incidence of malignancy.
- MRI, CT (Rarely indicated)
- Only to evaluate retro-sternal extension
- PET scan using FDGF18 (fluorodeoxyglucose F18)
- It can differentiate benign from malignant but highly expensive and can not replace biopsy
- Levothyroxine: (in benign nodule ) to keep TSH below 1 mU/L. It has many side effects, so not recommended.
- Surgery: indicated in
- FNAC positive or clinically suspicious (eldery, male, hard texture, fixed, recurrent laryngeal nerve palsy, lymphadenopathy, recurrent cyst)
- Cosmosis, Toxic nodule, Pressure symptoms
- Methods - Lobectomy + isthemusectomy: In pt with low risk factors & Benign
- Total thyroidectomy: In pt with high risk factors, Benign nodules & Malignant nodules
- Radioiodine: indicated in functioning nodule, contraindicated in pregnancy, lacatation, children. S/E: hypothyroidism, carcinogenic, fetal anomalies in pregnant women.
- Percutaneous ethanol injection, and laser photocoagulation.
According to American Thyroid Association & American Association of Clinical Endocrinology:
- Radionuclide scan is only indicated in:
- suppressed TSH
- if FNAC → follicular neoplasia
- FNAC should be guided by U/S especially if the nodule is partially cystic.
- Benign nodule → Life long Follow-up every year (TSH, neck palpation, FNAC), if functioning : Iodine -131 is TTT of choice, and Surgery is indicated in:
- very large nodule, Partially cystic, young patient, pregnant
- malignant nodule → surgry
- Autoimmune thyroidits → cortison + L-thyroxin
- Infections → control
Dubai Thyroid Clinic - DRHC provides treatment for hypothyroidism, hyperthyroidism, thyroid cancer, thyroid disease, thyroidectomy and thyroid surgery .