Toxic multinodular goiter other diagnostic studies
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mazia Fatima, MBBS [2]
Overview
The most important diagnostic test to differentiate thyroid nodules from each other is fine needle aspiration (FNA).
Other Diagnostic Studies
Fine needle aspiration
- The most important diagnostic test to differentiate thyroid nodules from each other is fine needle aspiration (FNA).
- Dominant cold nodule present in multinodular goiter is further investigated with fine needle aspiration biopsy.Autonomously functioning (hot) thyroid nodule is usually not an indication for fine-needle aspiration biopsy.
- Benign lesion and a malignant thyroid nodule can only be differentiated with histologic examination for the presence of vascular or capsular invasion.[1]
- As FNA is considered as an aggressive procedure, the American Thyroid Association developed the following criteria for FNA indication:
- Nodules ≥ 1 cm with intermediate or high suspicion US pattern
- Nodules ≥ 1.5 cm with low suspicion US pattern
- Nodules ≥ 2 cm with very low suspicion US pattern (e.g., spongiform). (Observation is an alternate option)
- For nodules that do not meet the above criteria, FNA is not required, including nodules < 1 cm (with some exceptions) and purely cystic nodules.[2]
- Criteria for US-guided FNA:
- FNA biopsy has a mean sensitivity higher than 80% and mean specificity higher than 90%.
- The accuracy of FNAB in diagnosing thyroid conditions is influenced by pathologist's experience and the technical skill of the physician performing the biopsy.
- Thyroid FNAB diagnostic categories and the respective risk of malignancy associated include:[3]
- Benign - < 1%
- Atypia of undetermined significance (AUS) - 5-10%
- Follicular neoplasm - 20-30%
- Suspicious for malignancy - 50-75%
- Malignant - 100%
Histologic Findings
- On microscopic histopathological analysis, several features such as adenomatous hyperplasia, cubical or cylindrical epithelium, resorption vesicles in the colloid, discrete fibrous capsule, secondary nodules and co-existing encapsulated adenomatous nodules with degenerative changes of fibrosis, calcification and hemorrhage characteristic findings of multinodular goiter.
- Multinodular goiter is associated with highly variable histological appearance involving the co-existence of normal sized follicles, microfollicles or macrofollicles within the same gland.
- In multinodular goiter many nodules may be monoclonal. A few autonomous nodules may be polyclonal.
- Micronodular growth pattern is seen in early goiters. Same follicle has cells in the resting phase and proliferating follicular cells with budding intraluminal projections.
- Some follicles have a more uniform appearance of cells. Areas of fresh and old hemorrhage with calcification can also be observed on histology.
References
- ↑ Cerci C, Cerci SS, Eroglu E, Dede M, Kapucuoglu N, Yildiz M, Bulbul M (2007). "Thyroid cancer in toxic and non-toxic multinodular goiter". J Postgrad Med. 53 (3): 157–60. PMID 17699987.
- ↑ Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L (2016). "2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer". Thyroid. 26 (1): 1–133. doi:10.1089/thy.2015.0020. PMC 4739132. PMID 26462967.
- ↑ Cibas ES, Ali SZ (2009). "The Bethesda System for Reporting Thyroid Cytopathology". Thyroid. 19 (11): 1159–65. doi:10.1089/thy.2009.0274. PMID 19888858.