of Thyroid Nodules甲状腺结节的评价课件.ppt

Evaluation of Thyroid Nodules Eric Oliver August 30, 2007 Objectives Discuss Common Causes of Thyroid Nodules Highlight Application of Imaging Studies in Evaluation of the Thyroid Nodule The Thyroid Nodule It is estimated that the prevalence of thyroid nodules in the general population is 4 - 7%. Benign adenomas or cysts account for approximately 90% of detected thyroid nodules. In the U.S., ~10,000 to 17,000 new cases of primary thyroid cancer are diagnosed each year. 1,000 - 2,000 people die each year from primary thyroid carcinomas. Causes of Thyroid Nodularity Benign Follicular Adenomas Multinodular goiter (colloid adenoma) Hashimoto’s thyroiditis Cysts (colloid, simple, hemorrhagic) Causes of Thyroid Nodularity Malignant Papillary Carcinoma Follicular Carcinoma Medullary Carcinoma Anaplastic and poorly differentiated carcinoma Primary lymphoma of the thyroid Metastatic carcinoma (especially breast and renal cell carcinoma) Low Suspicion Family history of autoimmune disease (eg, Hashimoto’s thyroiditis) Family history of benign thyroid nodule or goiter Presence of thyroid hormonal dysfunction Pain or tenderness associated with nodule Soft, smooth, and mobile nodule Hegedus: N Engl J Med, Volume 351(17).October 21, 2004.1764-1771 Case 1 A 16 year old female is seen because of a 6 month history of fatigue, nervousness, tremor, heat intolerance, polyphagia and weight loss. Her scholastic work has declined in quality. Recently she noticed some enlargement of her neck and prominence of her eyes. Physical examination reveals: B.P. 130/60 mm Hg., pulse 96/minute, smooth warm skin, eyelid retraction, symmetric thyroid enlargement, fine hand tremor and mild muscle weakness. Her TSH is low. Low TSH Suspect independently functioning thyroid ~10 percent of patients with a solitary nodule have a suppressed level of serum thyrotropin Next Step: Scintography Radionuclide Scanning Used to identify whether a nodule is functioning. Functioning nodules are nearly always benig