Thyroid nodule

Manage thyroid nodularity.

1st step: Determine whether a nodule is functional or nonfunctional. [Order TSH.]

  • Functional thyroid nodule: either low/high
    • Low TSH: Toxic multinodular goiter.
      • Next: Order Thyroid scintigraphy.
    • High TSH: Hashimoto thyroiditis.
      • Next: Order serum anti-thyroperoxidase (TPO) antibodies.
    • Nonfunctional thyroid nodule: Normal TSH

2nd step: Determine whether the nodule is malignant.

  • Fine needle aspiration (FNA) biopsy:
    • Malignant cytology -> surgical resection.
    • Indeterminate cytology -> thyroid scintigraphy.
      • Cold nodule (nonfunctioning): Surgery.
      • Hot nodule (functioning): Observe.
    • Benign cytology -> Clinical observation.

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