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Suggest Treatment For Thyroid Nodules
Question: I have been monitor three thyroid nodules since last year. Results from the most recent ultrasound show that two nodules have shrank at least half in diameter (one shrank from 21mm originally to 10mm, the other shrank from 9mm to 4mm), and another shrank a little bit from 11 mm to 9mm. The radiologist still want me to have all the nodules fine needle aspired, since they contain some high risk feature (one has internal vascularity, the other two has micro-calcification). Should I go ahead with the FNA? Since all my nodules shrank, shouldn't it be a sign of being benign?
Brief Answer:
Thyroid nodules
Detailed Answer:
As in many areas of Endocrinology, thyroid nodules also can be complex to understand and manage.
There are multiple risk factors for thyroid cancer in the nodules such as:
Past or Family history of thyroid cancer
Radiation exposure to the head/neck area (such radiation treatments for head/neck cancers)
Worrisome ultrasound characteristics (such as size, vascularity, calcifications, irregular margins etc)
So I see your radiologist noticed some such characteristics.
The general guidelines by the ATA (American Thyroid Association) are to consider FNA in nodules greater than 1 cm particularly if any suspicious features are present.
So by that token, you may wish to consider it too.
Moreover, the growth trend of nodules, is also an important factor. If the nodules are not increasing in size over time, it is a reassuring sign. But it is not as straightforward as tracking one dimension. It is the volume of the nodules that needs to be followed. Measuring volume requires 3 dimensions of each nodules Multiply all 3 dimensions and finally multiply the product by 0.55 to get the volume in cubic centimeters.
The general guideline is to consider FNA if the nodule has increased by more than 50% in the given interval of time.
This decision of watchful waiting versus intervening with FNA/surgery is individualized. An endocrinologist is best suited to guide you after having the opportunity to examine and counsel you in person.
Thyroid nodules
Detailed Answer:
As in many areas of Endocrinology, thyroid nodules also can be complex to understand and manage.
There are multiple risk factors for thyroid cancer in the nodules such as:
Past or Family history of thyroid cancer
Radiation exposure to the head/neck area (such radiation treatments for head/neck cancers)
Worrisome ultrasound characteristics (such as size, vascularity, calcifications, irregular margins etc)
So I see your radiologist noticed some such characteristics.
The general guidelines by the ATA (American Thyroid Association) are to consider FNA in nodules greater than 1 cm particularly if any suspicious features are present.
So by that token, you may wish to consider it too.
Moreover, the growth trend of nodules, is also an important factor. If the nodules are not increasing in size over time, it is a reassuring sign. But it is not as straightforward as tracking one dimension. It is the volume of the nodules that needs to be followed. Measuring volume requires 3 dimensions of each nodules Multiply all 3 dimensions and finally multiply the product by 0.55 to get the volume in cubic centimeters.
The general guideline is to consider FNA if the nodule has increased by more than 50% in the given interval of time.
This decision of watchful waiting versus intervening with FNA/surgery is individualized. An endocrinologist is best suited to guide you after having the opportunity to examine and counsel you in person.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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