Thyroid nodule qs - ihs2009

[ArchivalUser]

Hi, just wanted to confirm one thing, wht I think is one should go for FNAC for a thyroid nodule irrespective of its size, which is there in MTB, but Archers review says if the nodule is palpable do TSH, then proceed acoordingly, and if the nodule is >10mm, then do FNAC
Wht do u guys suggest as answer in exam
Thanks

[ArchivalUser]

First do TSH to see if you have a functioning nodule (low TSH) b/c there's no point in doing a biopsy of a nodular goiter. If TSH is normal, then proceed with the FNA.

[ArchivalUser]

yeah agree with mirina

[ArchivalUser]

according to usmle world for any nodule larger than 1cm, one should go for fnac

[ArchivalUser]

thts wht I am getting confused, because MTB says FNAC, and UW and Archers says TSH, even in stp2 CK, wht I remember is TSH, I have to check

[ArchivalUser]

TSH to start with.
there is good review in Archer Review
http://www.usmle3.com/2009/06/thyroid-no...tep-3.html
I verified it in the AACE link that they mentioned and all points are correct, you can stick with Archer and UW.

[ArchivalUser]

ihs2009 ...i think archer gives the most up-to-date . I agree with TSH first

[ArchivalUser]

thanks guys for all the input, this forum is a great help

[ArchivalUser]

definitely TSH first for incidental thyroid nodule. If TSH is not given in choices, then go for FNAC. And FNAC should be done if TSH normal. If TSH is low, then do T4, if its high too, then medical mgmt or hemithyroidectomy. IF t4 normal but TSH low, its subclinical hyperthyroidism- needs no treatment, only TSH followup.

correct me if i am wrong.

[ArchivalUser]

correction

they have said if low TSH, ie hot nodule, go for RAIU first. if it show hot nodule, treat with RAI if overt hyperthyroidism, or just followup if subclinical ! If cold, FNAC again.

rarely will TSH be high with thyroid nodule (Hashimoto),- probably wont be asked.

for incidentalomas found on USG, FNAC only if malignant features on USG (like irregular, microcalcifications), or if f/h of malign thyroid disease, or if >1 cm.