How shall we manage the incidentally found thyroid nodule?

Aspinall, Sebastian; Ong, Sarah G.S.; Wilson, Michael; Lennard, T. W. J.

doi:10.1016/j.surge.2012.11.004

Cited by 19 publications

(32 citation statements)

References 65 publications

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“…Thyroid incidentalomas can be found on palpation in only 4% to 21% of adult patients. [2][3][4] The prevalence of clinically unsuspected TIs reported at surgery and at autopsy is much higher: 50% to 67%. 5 Thyroid incidentalomas are much noted on US, in 10% to 67% of patients.…”

Section: Case 1: Malignant Timentioning

confidence: 99%

“…5 Thyroid incidentalomas are much noted on US, in 10% to 67% of patients. [2][3][4][5][6] Ultrasonography can detect lesions as small as a few millimeters in diameter even if the nodule is deeply located. 2 The lifetime probability of developing a thyroid nodule is 10%.…”

Section: Case 1: Malignant Timentioning

confidence: 99%

“…[6][7][8][9] It accounts for about 1% of all malignancies. 3 The malignancy rate of TIs is 4% to 12%, and it is generally independent of the nodule size. Less than 1-cm diameter papillary microcarcinomas incidentally found at the time of surgery are much more common (up to 36%).…”

Section: Case 1: Malignant Timentioning

confidence: 99%

“…The current patient management guidelines are cumbersome. 3 No protocol has been devised for anesthesiologists and pain specialists should they encounter an incidentaloma. The following cases illustrate the multifaceted nature and pros and cons of ignoring or investigating TIs.…”

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confidence: 99%

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Management of Thyroid Incidentalomas Encountered by Anesthesiologists and Pain Physicians

Narouze

Souzdalnitski

2013

Regional Anesthesia and Pain Medicine

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Unexpected, asymptomatic thyroid lesions incidentally discovered during unrelated diagnostic or therapeutic interventions are called thyroid incidentalomas (TIs). These lesions are extremely common, creating a clinical problem that most anesthesiologists and pain specialists are unfamiliar with. Ultrasonography (US), which allows high-quality real-time visualization of tissues during brachial plexus block, stellate ganglion block, central vascular access, and other interventions, is the imaging modality of choice of many anesthesiologists and pain medicine specialists for therapeutic interventions on the neck. The increasing number of US procedures performed on the neck will eventually result in an upsurge of anesthesiologists and pain specialists encountering a TI. Interventionalists are responsible for acquiring optimal images, accurate needle positioning during interventions, and storage and appropriate labeling of the obtained images. Ignoring the TI or disclosing the presence of a "tumor" can substantially affect the patient's well-being. In this literature review, we discuss 2 clinical cases of incidentalomas, summarize the current evidence-based strategies, and provide readers with practical guidelines-possibly applicable to other abnormal findings-for the management of incidentally found thyroid lesions.

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Section: Case 1: Malignant Timentioning

confidence: 99%

Section: Case 1: Malignant Timentioning

confidence: 99%

Section: Case 1: Malignant Timentioning

confidence: 99%

mentioning

confidence: 99%

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Management of Thyroid Incidentalomas Encountered by Anesthesiologists and Pain Physicians

Narouze

Souzdalnitski

2013

Regional Anesthesia and Pain Medicine

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“…Only 1 in 20 clinically detected thyroid nodules are malignant [2][3][4][5][6][7][8][9][10][11]. Several risk factors for malignant nodule have been identified (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Untitled

2016

JOENTR

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Thyroid nodules are common in ENT practice with a prevalence of 4-8% on clinical palpation and up to 8 -76% when evaluated with an Ultrasound Scan (US). When the nodule size is 1 cm or more it becomes clinically palpable. Approximately 5% of thyroid nodules are malignant. Detailed history and clinical examination are important in the evaluation of patients with thyroid nodules. Though US and Fine Needle Aspiration Cytology (FNAC) are useful investigations for thyroid nodules, it may not be possible to arrive at a diagnosis in all cases. Several US features suspicious for malignancy have been identified. Classification systems based on the FNAC results have been devised and are useful in surgical decision-making and management. Molecular testing can be used in nodules with FNAC results of atypia or follicular neoplasm, to stratify the risk of cancer. Patients with benign cytology may need a lobectomy for compressive symptoms or cosmetic concerns. Follicular lesions on FNAC need a diagnostic lobectomy followed by completion thyroidectomy, if proven to be malignant. Majority of the Differentiated Thyroid Cancers (DTC) will require total thyroidectomy, radio-active ablation and suppressive thyroxine therapy.

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