Thyroid nodule secondary prevention: Difference between revisions
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[[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. | [[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. | ||
== | == Secondary 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]]:<ref name="pmid17308855">{{cite journal |vauthors=Snook KL, Stalberg PL, Sidhu SB, Sywak MS, Edhouse P, Delbridge L |title=Recurrence after total thyroidectomy for benign multinodular goiter |journal=World J Surg |volume=31 |issue=3 |pages=593–8; discussion 599–600 |year=2007 |pmid=17308855 |doi=10.1007/s00268-006-0135-0 |url=}}</ref> | [[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]]:<ref name="pmid17308855">{{cite journal |vauthors=Snook KL, Stalberg PL, Sidhu SB, Sywak MS, Edhouse P, Delbridge L |title=Recurrence after total thyroidectomy for benign multinodular goiter |journal=World J Surg |volume=31 |issue=3 |pages=593–8; discussion 599–600 |year=2007 |pmid=17308855 |doi=10.1007/s00268-006-0135-0 |url=}}</ref><ref name="pmid18305998">{{cite journal |vauthors=Moalem J, Suh I, Duh QY |title=Treatment and prevention of recurrence of multinodular goiter: an evidence-based review of the literature |journal=World J Surg |volume=32 |issue=7 |pages=1301–12 |year=2008 |pmid=18305998 |doi=10.1007/s00268-008-9477-0 |url=}}</ref> | ||
=== Prevention of benign nodules | === Prevention of benign nodules === | ||
* [[Prevention]] of recurrence of benign thyroid nodules may be done by performing total [[thyroidectomy]]. | * [[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. | * Totaly [[thyroidectomy]] is not associated with an increased risk of permanent [[hypoparathyroidism]] or [[recurrent laryngeal nerve]] damage. | ||
=== Prevention of malignant nodules | === Prevention of malignant nodules === | ||
[[Secondary prevention]] of a thyroid nodule is aimed at the [[Prevention (medical)|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: | [[Secondary prevention]] of a thyroid nodule is aimed at the [[Prevention (medical)|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: | ||
Latest revision as of 20:34, 20 November 2017
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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
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 benign nodules
- 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.
Prevention of malignant nodules
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
- Measurement of serum thyroglobulin levels after total thyroidectomy.
- Post-op diagnostic radioactive iodine (RAI) scanning
- Post-op neck ultrasound
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
- Serum thyroglobulin levels
- Neck ultrasound
- Whole body scanning (not routinely indicated)
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
References
- ↑ 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.