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== Overview ==
==Screening==
Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. The American Thyroid Association has published guidelines for the management of thyroid nodules, which were updated in 2015. The major causes of thyroid nodule development include, [[Multinodular goiter|multinodular (sporadic) goiter]], [[Hashimoto's thyroiditis]], [[cysts]], macrofollicular/microfollicular adenomas, childhood [[radioiodine]] exposure, [[familial history]], and [[gene]] [[mutations]]. [[Neck masses]] can be mistaken for thyroid nodules. The most important [[neck masses]] that can be mistaken with thyroid nodules include, [[Thyroglossal cyst|thyroglossal]] duct cyst, [[parathyroid cancer]], [[Parathyroid gland|parathyroid]] cyst, and [[branchial cleft cyst]]. While the diagnosis of a thyroid nodule is established, thyroid nodule should be differentiated based on benign or [[malignant]] features and the type of nodule. Common [[risk factors]] associated with thyroid nodules include, older age, [[iodine deficiency]], previous history of [[iodine deficiency]] and [[hypothyroidism]], living in iodine deficient areas, family history of [[Autoimmune disease|autoimmune diseases,]] multiparity, and [[smoking]]. A solitary thyroid nodule may become [[symptomatic]] if it grows rapidly due to [[hemorrhage]] or [[malignancies]], invades [[Laryngeal nerve|laryngeal nerves]], compressing nearby structures, and secretory nodules that produce [[TSH]]. Thyroid nodules may be a manifestation of [[thyroid cancer]], that usually develops in the 6th decade of life, and start with [[symptoms]] such as [[weight loss]], [[fatigue]], and [[hoarseness]]. Without treatment, the patient with [[benign]] n<nowiki/>odules may remain [[asymptomatic]], while the patients with [[thyroid]] [[neoplasm]] may develop distant [[metastasis]], which may eventually lead to death. The most common complications of thyroid nodules are [[hoarseness]], [[horner's syndrome]], nodule rupture, needle track seeding, [[hemorrhage]]/[[hematoma]], [[dysphagia]], [[upper airway obstruction]], [[pain]], [[skin]] burn, [[Vasovagal Syncope|vasovagal reaction]], [[hypothyroidism]], transient [[thyrotoxicosis]], [[anaphylactic reaction]], [[thromboembolism]], and [[pneumothorax]]. Physical examination should focus on the [[thyroid gland]] and the lateral and central [[neck]] and should assess for [[supraclavicular]] and [[submandibular]] [[adenopathy]]. In case of active hot thyroid nodules that produce [[thyroid hormones]], [[Antithyroid agent|antithyroid drugs]] should be administered, that include [[beta-blockers]], antithyroid drugs ([[methimazole]],[[carbimazole]],[[propylthiouracil]]), [[Iodine-131|radioactive iodine]], and [[thyroidectomy]]. If the nodule excision treatment ([[lobectomy]], [[isthmectomy]], and total [[thyroidectomy]]) is not curative, then treatment with postoperative [[radioactive iodine]] ([[RAI1|RAI]]) remnant ablation and recombinant human TSH–mediated therapy is recommended. Surgical management of thyroid nodule is performed in case of non-diagnostic or suspicious biopsy, for removal of primary [[thyroid cancer]] or for [[thyroid cancer]] staging for [[radioactive]] ablation and [[serum]] [[thyroglobulin]] monitoring. [[Primary prevention]] of thyroid nodule is aimed at prevention of [[thyroid cancer]]. Avoidance of exposure to [[radiation]] and monitoring the population with an increased risk of development of a [[malignant]] thyroid nodule play major roles in [[primary prevention]]. [[Secondary prevention]] of thyroid nodules focuses on [[Prevention (medical)|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 (medical)|prevention]] of recurrence after removal of a primary nodule. Post-operative periodic monitoring with [[serum]] [[thyroglobulin]] levels, [[Radioactive iodine uptake|radioactive iodine scanning]], [[neck]] [[ultrasound]] and [[Thyroid-stimulating hormone|thyroid stimulating hormone]] ([[TSH]]) may decrease the chances of recurrence.
*According to the Endocrine Society and the European Society for Pediatric Endocrinology, screening for congenital hypothyroidism (cretinism) is recommended in all [[neonates]]. Screening is recommended because early detection of cretinism and early treatment will prevent the consequences of the disease which may be [[mental retardation]].<ref name="pmid24446653">{{cite journal| author=Léger J, Olivieri A, Donaldson M, Torresani T, Krude H, van Vliet G et al.| title=European Society for Paediatric Endocrinology consensus guidelines on screening, diagnosis, and management of congenital hypothyroidism. | journal=J Clin Endocrinol Metab | year= 2014 | volume= 99 | issue= 2 | pages= 363-84 | pmid=24446653 | doi=10.1210/jc.2013-1891 | pmc=4207909 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24446653  }}</ref>
*In a worldwide view of strategies, screening of cretinism is been held in many countries including the United States. The screening helped in detecting the newborn with [[hypothyroidism]]. These cases are around 2000 annually in the united states and 12,000 worldwide.<ref name="pmid24629860">{{cite journal| author=Ford G, LaFranchi SH| title=Screening for congenital hypothyroidism: a worldwide view of strategies. | journal=Best Pract Res Clin Endocrinol Metab | year= 2014 | volume= 28 | issue= 2 | pages= 175-87 | pmid=24629860 | doi=10.1016/j.beem.2013.05.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24629860  }}</ref>  
*The screening of cretinism can be performed through the following laboratory tests:<ref name="pmid8533594">{{cite journal| author=Asami T, Otabe N, Wakabayashi M, Kikuchi T, Uchiyama M| title=Congenital hypothyroidism with delayed rise in serum TSH missed on newborn screening. | journal=Acta Paediatr Jpn | year= 1995 | volume= 37 | issue= 5 | pages= 634-7 | pmid=8533594 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8533594  }}</ref><ref name="pmid23154158">{{cite journal| author=Büyükgebiz A| title=Newborn screening for congenital hypothyroidism. | journal=J Clin Res Pediatr Endocrinol | year= 2013 | volume= 5 Suppl 1 | issue=  | pages= 8-12 | pmid=23154158 | doi=10.4274/jcrpe.845 | pmc=3608007 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23154158 }}</ref>
**Measuring the level of [[Thyroxine|thyroxine hormone]] (T4)
**[[Blood]] [[TSH]] assay
**Both [[thyroxine]] and [[TSH]] levels

Revision as of 22:04, 20 November 2017

Screening

  • According to the Endocrine Society and the European Society for Pediatric Endocrinology, screening for congenital hypothyroidism (cretinism) is recommended in all neonates. Screening is recommended because early detection of cretinism and early treatment will prevent the consequences of the disease which may be mental retardation.[1]
  • In a worldwide view of strategies, screening of cretinism is been held in many countries including the United States. The screening helped in detecting the newborn with hypothyroidism. These cases are around 2000 annually in the united states and 12,000 worldwide.[2]
  • The screening of cretinism can be performed through the following laboratory tests:[3][4]
  1. ↑ Léger J, Olivieri A, Donaldson M, Torresani T, Krude H, van Vliet G; et al. (2014). "European Society for Paediatric Endocrinology consensus guidelines on screening, diagnosis, and management of congenital hypothyroidism". J Clin Endocrinol Metab. 99 (2): 363–84. doi:10.1210/jc.2013-1891. PMC 4207909. PMID 24446653.
  2. ↑ Ford G, LaFranchi SH (2014). "Screening for congenital hypothyroidism: a worldwide view of strategies". Best Pract Res Clin Endocrinol Metab. 28 (2): 175–87. doi:10.1016/j.beem.2013.05.008. PMID 24629860.
  3. ↑ Asami T, Otabe N, Wakabayashi M, Kikuchi T, Uchiyama M (1995). "Congenital hypothyroidism with delayed rise in serum TSH missed on newborn screening". Acta Paediatr Jpn. 37 (5): 634–7. PMID 8533594.
  4. ↑ Büyükgebiz A (2013). "Newborn screening for congenital hypothyroidism". J Clin Res Pediatr Endocrinol. 5 Suppl 1: 8–12. doi:10.4274/jcrpe.845. PMC 3608007. PMID 23154158.
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