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Thyroid nodule Plan

Thyroid ultrasound

TSH

Radioactive iodine uptake scan if suppressed TSH

Fine needle aspiration (FNA) if thyroid nodule >1-2 cm, risk factors*, suspicious findings on u/s

Endocrinology referral

ENT referral

Repeat thyroid ultrasound in 6 months if benign appearing nodule <1 cm with negative clinical history

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*Risk factors for thyroid cancer :

Head and neck radiation history (especially radiation exposure in childhood)

Palpable thyroid nodule is malignant in 20-50% of previously irradiated thyroid glands

Age <20 years old or over 70 years old

Male gender

Graves Disease

Hypofunctioning thyroid nodules have a risk of papillary thyroid cancer as high as 33 to 42%

Family history of thyroid cancer

Cancer syndromes

Familial adenomatous polyposis

Multiple endocrine neoplasia (MEN) type 2A or 2B

Rapid thyroid nodule growth

Hoarseness

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