Solitary thyroid nodule

Risks for cancer

Solitary thyroid nodules are worrisome in patients who have had prior radiation to the head and neck, and in those who have a family history of thyroid cancer.

Radiation exposure to the head and neck may be for historic indications such as tonsillar and adenoid hypertrophy, "enlarged thymus", acne vulgaris, or current indications such as Hodgkin's lymphoma. Children living near the Chernobyl nuclear power plant during the catastrophe of 1986 have experienced a 60-fold increase in the incidence of thyroid cancer. Thyroid cancer arising in the background of radiation is often multifocal with a high incidence of lymph node metastasis and has a poor prognosis.

Signs and symptoms

Worrisome signs and symptoms include voice hoarseness, rapid increase in size, compressive symptoms (such as dyspnoea or dysphagia) and appearance of lymphadenopathy.

Investigations

FNAC - fine needle aspiration cytology is the investigation of choice. Repeat the FNAC in 6months if the nodule enlarges.
Imaging - Ultrasound and radioiodine scanning.

Thyroid Scan

Cold - 85% of nodules are cold. Of these, up to 25% are malignant.

Hot - 5% of nodules are hot. Of these, 1% are malignant.

Surgery

Surgery should be performed in the following instances

Reaccumulation of the nodule despite 3-4 repeated FNACs
Size in excess of 4 cm
Complex cyst on thyroid ultrasound (showing solid and cystic components)
Compressive symptoms
Signs of malignancy (vocal cord dysfunction, lympadenopathy)

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