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Test Paper 4
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
A 35-year-old woman with a palpable nodule in the left lobe of the thyroid gland showed a corresponding area of low activity on nuclear medicine study consistent with a cold nodule. How would you investigate this patient further? MRI neckCT neck with contrastUS neckUS neck with FNASialogram
Thyroid nodules
Published in Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner, Endocrine Surgery, 2017
Salem I. Noureldine, Ralph P. Tufano
Radioiodine scans, using 123I, are useful for determining whether a thyroid nodule is autonomous in a patient with a suppressed serum TSH level. The term hot nodule is used when the nodule is suppressing the surrounding normal thyroid tissue, and warm nodule when it is functioning but does not suppress the surrounding thyroid tissue. A cold nodule is a nodule that is hypofunctioning in comparison with the surrounding thyroid tissue. Approximately 95% of nodules are cold on radioisotope scanning. The frequency of malignancy in cold nodules is 10%–15%, and 4% in hot nodules [13]. Thus, both hot and cold nodules are likely to be benign, and malignancy is only slightly more likely in cold nodules.
Applications of Radioisotopes in the Diagnosis and Treatment of Thyroid Disorders
Published in Madan Laxman Kapre, Thyroid Surgery, 2020
Chandrasekhar Bal, Meghana Prabhu, Dhritiman Chakraborty, K. Sreenivasa Reddy, Saurabh Arora
Thyroid nodules:Cold nodule: Approximately 85% to 90% of thyroid nodules are cold (hypofunctional) on thyroid scans. The incidence of cancer in a cold thyroid nodule is 15% to 20%. The dominant nodule is those that are distinctly larger than the other nodules in a multinodular goiter or those that are enlarging and require further evaluation. Differentials for cold nodule apart from malignancy include benign conditions such as colloid nodule, simple cyst, hemorrhagic cyst, adenoma, and abscess.Hot nodule: Radioiodine uptake in a nodule denotes function. A functioning nodule is very unlikely to be malignant. Less than 1% of hot nodules are reported to harbor malignancy. RAI is the usual therapy for toxic nodules because the radiation is delivered selectively to the hyperfunctioning tissue while sparing suppressed extranodular tissues. The suppressed thyroid tissue results in a low incidence of post-therapy hypothyroidism. After successful treatment, the suppressed tissue regains function. On occasion, surgery may be performed for patients with local symptoms or cosmetic concerns.Indeterminate nodule: When a palpable or sonographically detected nodule >1 cm cannot be differentiated by thyroid scan as definitely “hot or cold” compared to surrounding normal thyroid, it is referred to as an indeterminate nodule. The indeterminate nodule may occur with a posterior nodule that has normal thyroid uptake superimposed anterior to it, making it appear to have normal uptake. For management purposes, an indeterminate nodule has the same significance as a cold nodule.Discordant nodule: Some hot or warm nodules on thyroid scans appear cold on radioiodine scans. This type of observation occurs in only 5% of patients, because some thyroid cancers maintain trapping but not organification. Of discordant nodules, 20% are malignant.For any thyroid nodule >1 cm in any diameter, a serum TSH level should be initially obtained. If the serum TSH is subnormal, a radionuclide thyroid scan should be obtained to document whether the nodule is hyperfunctioning (“hot,” i.e., tracer uptake is higher than the surrounding normal thyroid), isofunctioning (“warm,” i.e., tracer uptake is equal to the surrounding thyroid), or nonfunctioning (“cold,” i.e., has uptake less than the surrounding thyroid tissue). Hyperfunctioning nodules rarely harbor malignancy, and no cytologic evaluation is necessary. A higher serum TSH level, even within the upper part of the reference range, is associated with increased risk of malignancy in a thyroid nodule, as well as more advanced stage thyroid cancer [11].
Nodule size as predictive factor of efficacy of radiofrequency ablation in treating autonomously functioning thyroid nodules
Published in International Journal of Hyperthermia, 2018
R. Cesareo, A. M. Naciu, M. Iozzino, V. Pasqualini, C. Simeoni, A. Casini, G. Campagna, S. Manfrini, G. Tabacco, A. Palermo
If we consider it true that the hypotheses of those authors who think that remission of functional symptoms is linked to the extent of volume reduction at 12 months (remission with an average reduction of 81%; improvement with an average reduction of 68%) [16], it is highly likely that it is necessary to induce a coagulation zone as wide as possible in order to achieve a high percentage of volume reduction. This substantially limits the vital marginal tissue at the periphery of the nodule, thereby preventing regrowth of the nodule over time with recurrence of hyperthyroidism. This is clearly more easily achieved with nodules of smaller volume. Our data are consistent with this hypothesis. At the 24th month after treatment, the percentage of euthyroid patients in the small-nodule group was 86%, much higher than the 45% of patients with nodules larger than 12 ml. Conversion to cold nodule status was seen in 86% of patients with nodules smaller than 12 ml at baseline, compared with 18% of patients with nodules larger than 12 ml.
Thyroid paraganglioma – a rare entity
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2023
K Naidu, V Saksenberg, MF Suliman, B Bhana
Thyroid ultrasonography generally shows a solid, hypoechoic nodule with increased peripheral and intranodal vascularity. Thyroid scintigraphy, which is rarely used nowadays in the evaluation of a non-functioning thyroid, often displays a ‘cold’ nodule. Contrast-enhanced CT and MRI scan characteristics are similar to imaging of carotid body PGs.11 Neuroendocrine tumours share a morphological kinship: they are often pleomorphic with tumour giant cells and spindle cells, and a medullary tumour would be considered the usual neuroendocrine tumour of the thyroid. As a result, TPGs are rarely diagnosed preoperatively with FNA or intraoperative frozen section histology.7,11
Safety and efficacy of thermal ablation (radiofrequency and laser): should we treat all types of thyroid nodules?†
Published in International Journal of Hyperthermia, 2019
Adrien Ben Hamou, Edouard Ghanassia, Stephanie Espiard, Henry Abi Rached, Arnaud Jannin, Jean Michel Correas, Christine Do Cao, Maeva Kyheng, Marie Christine Vantyghem, Herve Monpeyssen
Concerning indications, our study included a subgroup analysis according to the function and the structure of the nodules. The results show that the two techniques have similar efficacy for the treatment of autonomously functioning nodules but for cold nodule, RFA seem more efficient than laser ablation, confirming the data from literature [31,59]. Besides, a recent retrospective study that compared a single-session of RFA with radioiodine therapy did not show any differences concerning nodule volume reduction, but emphasized that RFA was effective in all patients with no case of post-treatment clinical hypothyroidism, and with no radiation exposure [60]. We highlighted a significant number of volume regrowth in solid nodule group than in mixed nodule group, regardless of the techniques used. We observed that for solid nodule, there was no difference between RFA and laser ablation concerning the percentage of volume reduction, but for cystic and mixed nodules, RFA seemed more efficient than laser ablation. This indicates that a nodule expert cartography must be carried out in the first place, with all the explorations performed in a standardized way to target precisely the indications and the technique to be used, and to provide clear information to the patient on the benefits and risks of the treatment. Indeed and in contrast with TA, surgery has the advantage of definitively treating benign nodules and allows a complete pathological study. Although we observed recurrence more frequently with laser ablation than RFA (about 11% vs. 5%), ending in surgery for three patients, the recurrences (regrowth) were not related to misrecognized cancers. These techniques may open up perspectives for the treatment of primary or locally recurrent thyroid carcinomas, particularly in non-operable patients [29,61].