Thyroid nodule differential diagnosis: Difference between revisions

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{{Thyroid nodule}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Thyroid_nodule]]
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== Overview ==
== Overview ==
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== Thyroid Nodule Differential Diagnosis ==
== Thyroid Nodule Differential Diagnosis ==
[[Neck masses]] can be mistaken with thyroid nodules. 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:
[[Neck masses]] can be mistaken with thyroid nodules. 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:
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== References ==
== References ==

Latest revision as of 19:22, 25 February 2019

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

Overview

Neck masses can be mistaken with thyroid nodules. The most important neck masses that can be mistaken with thyroid nodules include: Thyroglossal duct cyst, parathyroid cancer, 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.

Thyroid Nodule Differential Diagnosis

Neck masses can be mistaken with thyroid nodules. 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:

Disease Manifestation Spread Nodular growth Laboratory Imaging Pathology Associated findings
TSH FT4/T3
Colloid adenoma Intermediate

Slow

NL NL
  • Iso- to hypoechoic
  • May have internal cystic or heterogeneous change
  • May have calcification
  • Multiple echogenic foci (of inspissated colloid) with comet tail artifact
Hashimoto's thyroiditis Rapid

Intermediate

↓↓
  • Hypoechoic micronodules (1-6 mm) with surrounding echogenic septations
Cysts nodule Rapid

Intermediate

NL NL
  • Cystic non-calcified nodules
Disease Manifestation Spread Nodular growth TSH FT4/T3 Imaging Pathology Associated findings
Follicular adenoma Intermediate

Slow

↓↓
  • Thin peripheral halo
  • Predominantly cystic or mixed cystic and solid lesions
  • Isoechoic or predominantly anechoic
  • Depends on type
PAX8-PPAR gamma 1 
Hyperplastic nodule Rapid

Intermediate

↓↓
Macrofollicular adenoma Intermediate

Slow

↓↓
Microfollicular or cellular adenoma Intermediate

Slow

↓↓
Hürthle cell adenoma Intermediate

Slow

↑↓ ↑↓
Disease Manifestation Spread Nodular growth TSH FT4/T3 Imaging Pathology Associated findings
Papillary carcinoma Intermediate

Slow

NL NL
  • Unencapsulated and may be partially cystic
  • Papillae consisting of one or two layers of tumor cells surrounding a well-defined fibrovascular core
  • Large, oval, and appear crowded and overlapping nuclei
  • May contain hypodense powdery chromatin, cytoplasmic pseudoinclusions due to a redundant nuclear membrane, or nuclear grooves
Follicular carcinoma Intermediate

Slow

↑↓ ↑↓
  • Lesions are typically hypoechoic
  • Usually lacks cystic change
  • FLUS
  • Tumor capsule
  • Vascular invasion
  • RAS mutations
  • PAX8-PPAR gamma 1 
Medullary carcinoma
  • Malignant
  • Mainly manifest paraneoplastic symptoms:
  • Spread to lymph nodes
  • May spread to vessels
  • Metastasis locally to neck
  • Can metastasize to all body organ systems
Intermediate

Slow

NL NL
  • Unifocal
  • May present as multifocal
  • May be associated with other co-existing diseases
  • Associated with high levels of calcitonin
Disease Manifestation Spread Nodular growth TSH FT4/T3 Imaging Pathology Associated findings
Anaplastic carcinoma Slow Cytologically malignant:
  • P53
  • BRAF
Primary thyroid lymphoma Intermediate

Slow

NL NL
Metastatic carcinoma Intermediate

Slow

↑↓ ↑↓
Thyroglossal duct cyst[1]
  • Mostly midline
  • Can be painful if get infected
NL NL NA
Disease Manifestation Spread Nodular growth TSH FT4/T3 Imaging Pathology Associated findings
Branchial cleft cyst[2]
  • May adhere to great vessels at the mandibular angle
NL NL NA
Neck abscess[3] Rapid NL NL
  • Cyst with hyperechoic debris containing pus
NA
Parathyroid cyst[4]
  • Painless mass
Rapid

Intermediate

NL NL
  • Cystic lesion that is uniformly anechoic
NA
Parathyroid cancer[5] Slow

Intermediate

NL NL
  • Normal thyroid size with a complex echogenic structure
  • May contain hyperechoic solid part and several centrally located anechoic cavities
Disease Manifestation Spread Nodular growth TSH FT4/T3 Imaging Pathology Associated findings

References

  1. Yaman H, Durmaz A, Arslan HH, Ozcan A, Karahatay S, Gerek M (2011). "Thyroglossal duct cysts: evaluation and treatment of 49 cases". B-ENT. 7 (4): 267–71. PMID 22338239.
  2. Nahata V (2016). "Branchial Cleft Cyst". Indian J Dermatol. 61 (6): 701. doi:10.4103/0019-5154.193718. PMC 5122306. PMID 27904209.
  3. Bulgurcu S, Arslan IB, Demirhan E, Kozcu SH, Cukurova I (2015). "Neck abscess: 79 cases". North Clin Istanb. 2 (3): 222–226. doi:10.14744/nci.2015.50023. PMC 5175110. PMID 28058371.
  4. Ujiki MB, Nayar R, Sturgeon C, Angelos P (2007). "Parathyroid cyst: often mistaken for a thyroid cyst". World J Surg. 31 (1): 60–4. doi:10.1007/s00268-005-0748-8. PMID 17180630.
  5. Solomon PR, Pendlebury WW (1988). "A model systems approach to age-related memory disorders". Neurotoxicology. 9 (3): 443–61. PMID 3059245.