Thyroid nodule secondary prevention

	Thyroid nodule Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Thyroid nodule from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic study of choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Thyroid nodule secondary prevention On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Thyroid nodule secondary prevention All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Thyroid nodule secondary prevention
CDC on Thyroid nodule secondary prevention
Thyroid nodule secondary prevention in the news
Blogs on Thyroid nodule secondary prevention
Directions to Hospitals Treating Thyroid nodule
Risk calculators and risk factors for Thyroid nodule secondary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

Secondary prevention of thyroid nodules focuses on prevention of recurrence of nodules. Different prevention strategies may be used depending upon whether the nodule is benign or malignant. In case of a malignant nodule, the major focus is on the prevention of recurrence after removal of a primary nodule. Post-operative periodic monitoring with serum thyroglobulin levels, radioactive iodine scanning, neck ultrasound and thyroid stimulating hormone (TSH) may decrease the chances of recurrence.

Secondary prevention of thyroid nodules focuses on prevention of recurrence of nodules. Different prevention strategies may be used depending upon whether the nodule is benign or malignant:^[1]^[2]

Prevention of recurrence of benign thyroid nodules may be done by performing total thyroidectomy.
Totaly thyroidectomy is not associated with an increased risk of permanent hypoparathyroidism or recurrent laryngeal nerve damage.

Secondary prevention of a thyroid nodule is aimed at the prevention of recurrence after removal of a primary nodule (specially in case of malignant lesions). The following steps outline the secondary prevention of malignant thyroid nodules:

1. Routine screening for disease recurrence

2. Serum TSH goals

Maintain TSH levels between:
- Non-stimulated thyroglobulin < 0.2 ng/ml : TSH should be 0.5-2.0 mU/L
- Non-stimulated thyroglobulin greater than equal to 0.2 ng/ml: TSH should be 0.1-0.5 mU/L

3. Evaluation of response to therapy

4a. Excellent response to therapy

Primary follow-up with clinical exam and non-stimulated thyroglobulin levels (TSH goal 0.5-2 mU/L)
Non-stimulated thyroglobulin levels at 12-24 month intervals
Periodic neck ultrasound

↑ Snook KL, Stalberg PL, Sidhu SB, Sywak MS, Edhouse P, Delbridge L (2007). "Recurrence after total thyroidectomy for benign multinodular goiter". World J Surg. 31 (3): 593–8, discussion 599–600. doi:10.1007/s00268-006-0135-0. PMID 17308855.
↑ Moalem J, Suh I, Duh QY (2008). "Treatment and prevention of recurrence of multinodular goiter: an evidence-based review of the literature". World J Surg. 32 (7): 1301–12. doi:10.1007/s00268-008-9477-0. PMID 18305998.