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Evaluation of the Thyroid Nodule

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Part of the book series: Cancer Treatment and Research ((CTAR,volume 153))

Abstract

Thyroid nodules are very common in the general population. The prevalence of palpable thyroid nodules is only approximately 4–7%, but the prevalence of ultrasound–detectable nodules is between 19 and 67% [1]. Twenty to forty–eight percent of patients with apparently solitary thyroid nodules palpated on physical exam will have additional sonographically detectable nodules [2,3]. Thyroid nodules are more common in women than in men by a ratio of about 4 to 1, and increase in frequency with age and with decreasing iodine intake 4]. Thyroid nodules are also more common in patients who have a history of head and neck irradiation, developing at a rate of about 2% per year compared with 0.1% per year in patients without a history of significant radiation exposure [5].

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References

  1. Tan GH, Gharib H (1997) Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med 126:226–231

    CAS  PubMed  Google Scholar 

  2. Walker J, Findlay D, Amar SS, Small PG, Wastie ML, Pegg CA (1985) A prospective study of thyroid ultrasound scan in the clinically solitary thyroid nodule. Br J Radiol 58:617–619

    Article  CAS  PubMed  Google Scholar 

  3. Tan GH, Gharib H, Reading CC (1995) Solitary thyroid nodule. Comparison between palpation and ultrasonography. Arch Intern Med 155:2418–2423

    Article  CAS  PubMed  Google Scholar 

  4. Hegedus L (2004) Clinical practice. The thyroid nodule. N Engl J Med 351:1764–1771

    Article  PubMed  Google Scholar 

  5. National Comprehensive Cancer Network (2008) Clinical Practice Guidelines in Oncology: Thyroid Carcinoma V.I.2008. http://www.nccn.org/professionals/physician_gls/PDF/thyroid.pdf Accessed 1 Nov 2008

  6. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi (2006) Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 12:63–102

    Google Scholar 

  7. Cooper DS, Doherty GM, Haugen BR et al (2006) Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16:109–142

    Article  PubMed  Google Scholar 

  8. Jemal A, Siegel R, Ward E et al (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96

    Article  PubMed  Google Scholar 

  9. Davies L, Welch HG (2006) Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 295:2164–2167

    Article  CAS  PubMed  Google Scholar 

  10. Mazzaferri EL, Jhiang SM (1994) Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 97:418–428

    Article  CAS  PubMed  Google Scholar 

  11. Ron E (1998) Ionizing radiation and cancer risk: evidence from epidemiology. Radiat Res 150:S30–S41

    Article  CAS  PubMed  Google Scholar 

  12. Shibata Y, Yamashita S, Masyakin VB, Panasyuk GD, Nagataki S (2001) 15 years after Chernobyl: new evidence of thyroid cancer. Lancet 358:1965–1966

    Article  CAS  PubMed  Google Scholar 

  13. Imaizumi M, Usa T, Tominaga T et al (2006) Radiation dose–response relationships for thyroid nodules and autoimmune thyroid diseases in Hiroshima and Nagasaki atomic bomb survivors 55–58 years after radiation exposure. JAMA 295:1011–1022

    Article  CAS  PubMed  Google Scholar 

  14. Goldgar DE, Easton DF, Cannon-Albright LA, Skolnick MH (1994) Systematic population-based assessment of cancer risk in first-degree relatives of cancer probands. J Natl Cancer Inst 86:1600–1608

    Article  CAS  PubMed  Google Scholar 

  15. Hemminki K, Eng C, Chen B (2005) Familial risks for nonmedullary thyroid cancer. J Clin Endocrinol Metab 90:5747–5753

    Article  CAS  PubMed  Google Scholar 

  16. Musholt TJ, Musholt PB, Petrich T, Oetting G, Knapp WH, Klempnauer J (2000) Familial papillary thyroid carcinoma: genetics, criteria for diagnosis, clinical features, and surgical treatment. World J Surg 24:1409–1417

    Article  CAS  PubMed  Google Scholar 

  17. Evans DB, Shapiro SE, Cote GJ (2007) Invited commentary: medullary thyroid cancer: the importance of RET testing. Surgery 141:96–99

    Article  PubMed  Google Scholar 

  18. Boelaert K, Horacek J, Holder RL, Watkinson JC, Sheppard MC, Franklyn JA (2006) Serum thyrotropin concentration as a novel predictor of malignancy in thyroid nodules investigated by fine-needle aspiration. J Clin Endocrinol Metab 91:4295–4301

    Article  CAS  PubMed  Google Scholar 

  19. Schlosser K, Zeuner M, Wagner M, et al (2007) Laryngoscopy in thyroid surgery – essential standard or unnecessary routine? Surgery 142:858–864; discussion 64 e1–e2

    Google Scholar 

  20. Randolph GW, Kamani D (2006) The importance of preoperative laryngoscopy in patients undergoing thyroidectomy: voice, vocal cord function, and the preoperative detection of invasive thyroid malignancy. Surgery 139:357–362

    Article  PubMed  Google Scholar 

  21. Jarhult J, Lindestad PA, Nordenstrom J, Perbeck L (1991) Routine examination of the vocal cords before and after thyroid and parathyroid surgery. Br J Surg 78:1116–1117

    Article  CAS  PubMed  Google Scholar 

  22. Frates MC, Benson CB, Charboneau JW et al (2005) Management of thyroid nodules detected at US: society of radiologists in ultrasound consensus conference statement. Radiology 237:794–800

    Article  PubMed  Google Scholar 

  23. Papini E, Guglielmi R, Bianchini A et al (2002) Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab 87:1941–1946

    Article  CAS  PubMed  Google Scholar 

  24. Chu QD, Connor MS, Lilien DL, Johnson LW, Turnage RH, Li BD (2006) Positron emission tomography (PET) positive thyroid incidentaloma: the risk of malignancy observed in a tertiary referral center. Am Surg 72:272–275

    PubMed  Google Scholar 

  25. King DL, Stack BC Jr, Spring PM, Walker R, Bodenner DL (2007) Incidence of thyroid carcinoma in fluorodeoxyglucose positron emission tomography-positive thyroid incidentalomas. Otolaryngol Head Neck Surg 137:400–404

    Article  PubMed  Google Scholar 

  26. Are C, Hsu JF, Schoder H, Shah JP, Larson SM, Shaha AR (2007) FDG-PET detected thyroid incidentalomas: need for further investigation? Ann Surg Oncol 14:239–247

    Article  PubMed  Google Scholar 

  27. Kim TY, Kim WB, Ryu JS, Gong G, Hong SJ, Shong YK (2005) 18F-fluorodeoxyglucose uptake in thyroid from positron emission tomogram (PET) for evaluation in cancer patients: high prevalence of malignancy in thyroid PET incidentaloma. Laryngoscope 115:1074–1078

    Article  PubMed  Google Scholar 

  28. Polyzos SA, Kita M, Efstathiadou Z et al (2008) Serum thyrotropin concentration as a biochemical predictor of thyroid malignancy in patients presenting with thyroid nodules. J Cancer Res Clin Oncol 134:953–960

    Article  CAS  PubMed  Google Scholar 

  29. Haymart MR, Repplinger DJ, Leverson GE et al (2008) Higher serum thyroid stimulating hormone level in thyroid nodule patients is associated with greater risks of differentiated thyroid cancer and advanced tumor stage. J Clin Endocrinol Metab 93:809–814

    Article  CAS  PubMed  Google Scholar 

  30. Cheung K, Roman SA, Wang TS, Walker HD, Sosa JA (2008) Calcitonin measurement in the evaluation of thyroid nodules in the United States: a cost-effectiveness and decision analysis. J Clin Endocrinol Metab 93:2173–2180

    Article  CAS  PubMed  Google Scholar 

  31. Elisei R, Bottici V, Luchetti F et al (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 Endocrinol Metab 89:163–168

    Article  CAS  PubMed  Google Scholar 

  32. Costante G, Meringolo D, Durante C et al (2007) Predictive value of serum calcitonin levels for preoperative diagnosis of medullary thyroid carcinoma in a cohort of 5817 consecutive patients with thyroid nodules. J Clin Endocrinol Metab 92:450–455

    Article  CAS  PubMed  Google Scholar 

  33. Vierhapper H, Niederle B, Bieglmayer C, Kaserer K, Baumgartner-Parzer S (2005) Early diagnosis and curative therapy of medullary thyroid carcinoma by routine measurement of serum calcitonin in patients with thyroid disorders. Thyroid 15:1267–1272

    Article  CAS  PubMed  Google Scholar 

  34. Gharib H, Goellner JR (1993) Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med 118:282–289

    CAS  PubMed  Google Scholar 

  35. Grant CS, Hay ID, Gough IR, McCarthy PM, Goellner JR (1989) Long-term follow-up of patients with benign thyroid fine-needle aspiration cytologic diagnoses. Surgery 106:980–985; discussion 5–6

    Google Scholar 

  36. Mazzaferri EL (1993) Management of a solitary thyroid nodule. N Engl J Med 328:553–559

    Article  CAS  PubMed  Google Scholar 

  37. Alexander EK, Heering JP, Benson CB et al (2002) Assessment of nondiagnostic ultrasound-guided fine needle aspirations of thyroid nodules. J Clin Endocrinol Metab 87:4924–4927

    Article  CAS  PubMed  Google Scholar 

  38. McHenry CR, Walfish PG, Rosen IB (1993) Non-diagnostic fine needle aspiration biopsy: a dilemma in management of nodular thyroid disease. Am Surg 59:415–419

    CAS  PubMed  Google Scholar 

  39. National Cancer Institute Thyroid Fine Needle Aspiration (FNA) State of the Science Conference (2008) http://thyroidfna.cancer.gov/pages/conclusions/. Accessed 1 Nov 2008

  40. Ylagan LR, Farkas T, Dehner LP (2004) Fine needle aspiration of the thyroid: a cytohistologic correlation and study of discrepant cases. Thyroid 14:35–41

    Article  PubMed  Google Scholar 

  41. McCoy KL, Jabbour N, Ogilvie JB, Ohori NP, Carty SE, Yim JH (2007) The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size. Surgery 142:837–844; discussion 44 e1–e3

    Google Scholar 

  42. Meko JB, Norton JA (1995) Large cystic/solid thyroid nodules: a potential false-negative fine-needle aspiration. Surgery 118:996–1003; discussion 1003–1004

    Google Scholar 

  43. Kuma K, Matsuzuka F, Kobayashi A, et al (1992) Outcome of long standing solitary thyroid nodules. World J surg 16:583–587; discussion 7–8

    Google Scholar 

  44. Alexander EK, Hurwitz S, Heering JP et al (2003) Natural history of benign solid and cystic thyroid nodules. Ann Intern Med 138:315–318

    PubMed  Google Scholar 

  45. Kebebew E, Peng M, Reiff E, Duh QY, Clark OH, McMillan A (2005) ECM1 and TMPRSS4 are diagnostic markers of malignant thyroid neoplasms and improve the accuracy of fine needle aspiration biopsy. Ann surg 242:353–361; discussion 61–63

    Google Scholar 

  46. Bartolazzi A, Orlandi F, Saggiorato E et al (2008) Galectin-3-expression analysis in the surgical selection of follicular thyroid nodules with indeterminate fine-needle aspiration cytology: a prospective multicentre study. Lancet oncol 9:543–549

    Article  CAS  PubMed  Google Scholar 

  47. Ross DS, Ridgway EC, Daniels GH (1984) Successful treatment of solitary toxic thyroid nodules with relatively low-dose iodine-131, with low prevalence of hypothyroidism. Ann Intern Med 101:488–490

    CAS  PubMed  Google Scholar 

  48. Ratcliffe GE, Cooke S, Fogelman I, Maisey MN (1986) Radioiodine treatment of solitary functioning thyroid nodules. Br J Radiol 59:385–387

    Article  CAS  PubMed  Google Scholar 

  49. Huysmans DA, Corstens FH, Kloppenborg PW (1991) Long-term follow-up in toxic solitary autonomous thyroid nodules treated with radioactive iodine. J Nucl Med 32:27–30

    CAS  PubMed  Google Scholar 

  50. O’Brien T, Gharib H, Suman VJ, van Heerden JA (1992) Treatment of toxic solitary thyroid nodules: surgery versus radioactive iodine. Surgery 112:1166–1170

    PubMed  Google Scholar 

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Correspondence to Dina M. Elaraj .

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Elaraj, D.M. (2010). Evaluation of the Thyroid Nodule. In: Sturgeon, C. (eds) Endocrine Neoplasia. Cancer Treatment and Research, vol 153. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-0857-5_2

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  • DOI: https://doi.org/10.1007/978-1-4419-0857-5_2

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