Thyroid Ultrasound > Top 10 High-Yield Ponits

Top 10 High-Yield Ponits

1. With the odds of malignancy in biopsied nodes being approximately 1 in 20, and thyroid cancer accounting for only 0.5% of all cancer deaths, a sensible strategy for determining which nodules should undergo FNA is essential.

2. Sonographic characteristics are superior to nodule size for identifying nodules that are more likely to be malignant and include the presence of microcalcifications, hypoechogenicity of a solid nodule, and intranodular hypervascularity.

3. FNA is likely unnecessary in diffusely enlarged gland with multiple nodules of similar US appearance without intervening parenchyma.

4. For nodules less than 1.5 cm, FNA should be considered only for those isofunctioning or nonfunctioning (cold) nodules, among which those with suspicious sonographic features should be aspirated preferentially.

5. Nodules measuring 1 cm or greater detected on CT or smaller nodules with worrisome CT features, such as calcifications or invasion of surrounding structures, should be referred for ultrasound evaluation and ultimately FNA.

6. At this point, given the limitations of CT, it is probably prudent to report all thyroid nodules less than 1 cm incidentally detected on CT. However, it is not reasonable to advise a follow-up ultrasound examination in every patient, and it should be left up to the clinician who has full access to clinical information and the medical history of these patients.

7. Postoperative remnant ablation (usually I-131) should be performed for all patients with differentiated thyroid carcinoma 45 years of age or older, those with primary tumor 1.5 cm or greater, and those with extrathyroidal disease.

8. The chance of a FDG active lesion in the thyroid being malignancy, is 1 in 3 and therefore biopsy is recommended. There is a higher chance that this is primary thyroid carcinoma rather than metastasis. Other malignancies metastasizing to thyroid include lung, breast, colon, renal and melanoma.

9. The two most reliable benign features are a near-complete cystic appearance and also a reliable presence of ring-down arifact in colloid cysts/nodules.

10. Clinical factors favoring malignancy include: young, male, history of radiation, hard lesion,other masses in neck,family history and lack of shrinkage on thyroide hormone. Factors favoring a benign lesion include older patients, female, sudden onset, tender or soft lesion, shrinkage on thyroide hormones.

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