Thyroid nodule differential diagnosis: Difference between revisions

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! colspan="3" |Nodule property
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! colspan="3" |Spread
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! rowspan="2" |Sudden growth
! rowspan="2" |Sudden growth
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|Metastatic carcinoma
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* Can be painful if get infected
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Revision as of 20:36, 9 August 2017

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

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Risk calculators and risk factors for Thyroid nodule differential diagnosis

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

Overview

Thyroid nodule differential diagnosis

In rare cases, a thyroid nodule may reflect one of the hereditary nonmedullary thyroid cancer syndromes such as familial adenomatous polyposis, Werner’s syndrome, Carney complex type 1, or Gardner’s syndrome

Nodule property Spread Sudden growth

of neck mass

Laboratory Thyroid scintigraphy Biopsy result

if indicated

LN Vessle Metastasis TSH FT4/T3 Hot Cold US finding FNA finding Associated mutation special consideration
Benign Colloid adenoma
Hashimoto's thyroiditis
  • Rarely painful
 - - +
Cysts nodules
  • Follicular cells
  • Macrophages
  • RBC
  • Colloid
Follicular adenomas ↑↑↑
  • PAX8-PPAR gamma 1 
Hyperplastic nodules ↑↑↑
Macrofollicular adenomas ↑↑
Microfollicular or cellular adenomas ↑↑
Hürthle cell adenomas ↑↓
Malignant Papillary carcinoma
  • Fixed nodules
 ↑↑↑ ↑↑↑
  • Pulmonary
  • Skeletal metastases
 + multifocal unencapsulated and may be partially cystic papillae consisting of one or two layers of tumor cells surrounding a well-defined fibrovascular core; follicles and colloid are typically absent

The nuclei are large, oval, and appear crowded and overlapping on microscopic sections. They may contain hypodense powdery chromatin, cytoplasmic pseudoinclusions due to a redundant nuclear membrane, or nuclear grooves.

  • RET/PTC
  • NTRK1
  • RAS
  • BRAF 
Follicular carcinoma Fixed nodules ↑↑↑ Bone

Lung

↑↓ Unifocal FLUS
  • Tumor capsule
  • Vascular invasion
  • RAS mutations
  • PAX8-PPAR gamma 1 
 Most common thyroid cancer in iodine deficient areas
Oxyphilic (Hürthle cell) type carcinoma
Medullary carcinoma ↑↑↑ Unifocal

May present as multifocal

hypoechoic, microcalcifications
Anaplastic carcinoma ↑
Primary thyroid lymphoma
Metastatic carcinoma
Thyroglossal duct cysts 
  • Mostly midline
  • Can be painful if get infected
Parathyroid cysts

References

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