Thyroid Nodule

  • The most important risk factor of thyroid nodule is age
  • Family history is especially important in medullary thyroid cancer -> hereditary
  • Well-differentiated thyroid cancers -> papillary (most common) + follicular
  • The worst thyroid cancer is anaplastic
  • If you suspect medullary thyroid cancer -> do calcitonin (normal is zero in our body)
  • Medullary thyroid cancer -> do total thyroidectomy + F\U calcitonin and PET to assess recurrence or metastasis
  • Most important investigation for thyroid nodule?
    • US
    • FNA
  • How to know LN involvement using US? Preserved hilar fat in LN -> less likely to be malignant
  • CT scan is used for very large thyroid or retrosternal mass
  • MRI is used if suspicion of invasion of trachea, muscle, or thyroid cartilage
  • Thyroid scan can be used for well-differentiated thyroid cancer post-op to assess recurrence or metastasis -> uptake of radio-active iodine

Thyroid nodule 1


Bathesda system:

  1. Insufficient for dx -> might be cyst -> F\U 3 mo
  2. Benign -> F\U
  3. Atypia of undetermined significance -> repeat
  4. Suspicious for follicular\Hurthle cell neoplasm -> either total or hemi thyroidectomy
  5. Suspicious for malignancy (usually papillary ca) -> total thyroidectomy
  6. Malignant -> thyroidectomy


  • For medullary thyroid cancer -> do primary thyroid surgery (usually total thyroidectomy) + central neck dissection
  • For anaplastic thyroid cancer -> do debulking + tracheostomy


  • Radioactive iodine:
    • Diagnostic: i 123
    • Therapeutic: i 131


Download the PDF version: here


  • Dr Alshehri’s lecture

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