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SOLITARY THYROID NODULE

SOLITARY THYROID NODULE. Schwartz’s MANUAL OF SURGERY. 2010. Solitary thyroid nodules are present in approximately 4 percent of the population . Thyroid cancer has a much lower incidence of 40 new cases per1 million.

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SOLITARY THYROID NODULE

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  1. SOLITARY THYROID NODULE

  2. Schwartz’sMANUAL OFSURGERY 2010

  3. Solitary thyroid nodules are present in approximately 4 percent of the population . • Thyroid cancer has a much lower incidence of 40 new cases per1 million. • Details regarding the nodule :time of onset, change in size, pain, dysphagia, dyspnea, or choking .

  4. A history of hoarseness is worrisome because it may be secondary to malignant involvement of the recurrent laryngeal nerves. • Risk factors for malignancy, such as exposure to ionizing radiation and family history of thyroid and other malignancies .

  5. Nodules that are hard, gritty, or fixed to surrounding structures, such as to the trachea or strap muscles, are more likely to be malignant . • Afine-needle aspiration biopsy is the most important diagnostic test .

  6. Benign (65 percent),suspicious (20 percent), malignant (5 percent), and nondiagnostic (10 percent) . • The incidence of false-positive results is approximately 1 percent and false negative results occur in approximately 3 percent of patients.

  7. The risk of malignancy in this setting is less than 3 percent. • The risk of malignancy in the suspicious cytology is anywhere from 10–20 percent. • FNA biopsy also is less reliable in patients who have a history of head and neck irradiation or a family history of thyroid cancer, because of a higher likelihood of cancer and coexistent benign and malignant lesions.

  8. patient with a nodule is found to be hyperthyroid, the risk of malignancy is approximately 1 percent. • Ultrasound is helpful for detecting nonpalpable thyroid nodules, for differentiating solid from cystic nodules. • CT scan & MRI are unnecessary in the routine evaluation of thyroid tumors except for large, fixed, or substernal lesions .

  9. 123I or 99mTc is rarely necessary, just in “hot” or autonomous thyroid nodules. • Thyroidectomy should be performed if a nodule enlarges on TSH suppression, causes compressive symptoms, or for cosmetic reasons.

  10. patient who has had previous irradiation of the thyroid gland or who has a family history of thyroid cancer. In these patients total or neartotalthyroidectomy is recommended because of the high incidence of thyroid cancer (≥ 40 percent) and decreased reliability of FNA biopsy .

  11. Sabiston Textbook of Surgery 18th ed.

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