solitary thyroid nodule

All of the following are true about solitary thyroid nodule except:

a. Presence of a toxic solitary nodule is an indication for isotope scanning. 

b. Autoantibody status helps us to rule out chronic lymphocytic thyroiditis.

c. An isolated thyroid swelling which is cystic has an increased risk of malignancy compared to its solid counterpart. 

d.An isolated thyroid swelling which is solid has an increased risk of malignancy compared to its cystic counterpart.

e. A male having a solid isolated thyroid swelling has an increased risk of developing malignancy compared to females.

f. Microcalcifications in thyroid swelling are associated with neoplasia.   

g. In a partly solid and partly cystic nodule, cystic areas are targetted for FNAC.

Answer:

c,g

Serum TSH and thyroid hormone levels should be measured. If hyperthyroidism associated with a discrete swelling is confirmed biochemically, it indicates either a ‘toxic adenoma’ or a manifestation of toxic multinodular goitre. The combination of toxicity and nodularity is important and is an indication for isotope scanning to localise the area(s) of hyperfunction.

AUTOANTIBODY TITRES: The autoantibody status may determine whether a swelling is a manifestation of chronic lymphocytic thyroiditis. The presence of circulating antibodies increases the risk of thyroid failure after lobectomy.

ISOTOPE SCAN

Isotope scanning used to be the mainstay of investigation of discrete thyroid swellings but has been abandoned except when toxicity is associated with nodularity.

ULTRASONOGRAPHY

This is gold standard investigation to determine the physical characteristics of thyroid swellings. There are a number of ultrasonic features in a thyroid swelling associated with thyroid neoplasia, including microcalcification and increased vascularity, but only macroscopic capsular breach and nodal involvement are diagnostic of malignancy. Ultrasound should be used as the primary investigation of any thyroid nodule as a reassuring appearance mitigates the need for an FNAC (see

below).

FNAC is both highly specific and sensitive. Using ultrasound improves this further, particularly in part cystic, part solid nodules in which ultrasound allows targeting of the solid element for biopsy.

Reference: Bailey and Love 27th edition.