Nuclear Medicine

Presentation Topic:

Young Woman With A

Thyroid Nodule
PRESENTED TO:
DR. MAHRUKH LATIF
PRESENTED BY:
MID-10TH SEMESTER, SECTION-A
GROUP-22
I- KINZA NOOR
II- RIMSHA GHULAM MUSTAFA
THYROID NUDULE:

► Thyroid nodules are solid or fluid-filled lumps

that form within your thyroid, a small gland
located at the base of your neck, just above
your breastbone.
► Most thyroid nodules aren't serious. Only a
small percentage of thyroid nodules are
cancerous.

Causes:
► Thyroid nodules are caused by an overgrowth
of cells in the thyroid gland. These growths
can be: Not cancer (benign), thyroid cancer
(malignant), or very rarely, other cancers or
infections.
Symptoms:

► Thyroid nodules usually do not cause symptoms. For this reason, they’re often
found by a healthcare provider during a routine neck examination or an
imaging test done for another reasons like; CAD, cervical spine pain, trauma etc.
► When thyroid nodules do produce symptoms, the most common are a lump in
the neck and a sense of mass while swallowing (and possibly difficulty
swallowing). In addition, larger nodules may cause difficulty breathing,
hoarseness, and neck pain.
► Rarely, the tissue in a thyroid nodule makes too much of the thyroid hormones
triiodothyronine (T3) and thyroxine (T4), which can lead to symptoms of
hyperthyroidism (overactive thyroid). These include:
Anxiety, Irritability or moodiness, Nervousness, hyperactivity, Sweating or
sensitivity to high temperatures, Rapid heart rate, Hand trembling (shaking), Hair
loss, Frequent bowel movements or diarrhea, Weight loss, Missed or light
Case summary:

► Age: 36 years old

► Gender: Female
► Clinical history: She is well, but on specific questioning reports a
weight loss of about 3kgs over the past month and some
mild heat intolerance.
► Physical exam: Slight swelling felt on the base of neck
► Previous history: Thyroid function tests demonstrate a suppressed
serum TSH with a mildly elevated serum T3.
Imaging Findings:

► A Thyroid scan was performed.

► Thyroid scan demonstrates that the palpable nodule
is located in the upper pole of the left lobe of the
thyroid, 1.5cm in size and this nodule is
hyperfunctioning or “hot”.

► On Ultrasound the nodule is measured 1.47 cm in size.

► Hyperechoic, regular margins and peripheral
vascularity on Doppler ultrasound are seen.
► Suggestive of a benign thyroid nodule.
Differencial Diagnosis:

Neck masses can be mistaken with thyroid nodules. The most important
neck masses that can be mistaken with thyroid nodules include:
► Thyroglossal duct cyst
► Parathyroid cancer
► Parathyroid cyst and
► Branchial cleft cyst.
Treatment:

► Radioactive iodine: Doctors use radioactive iodine to treat

hyperthyroidism.
► Anti-thyroid medications: In some cases, your doctor may
recommend an anti-thyroid medication such as methimazole
(Tapazole) to reduce symptoms of hyperthyroidism.
► Surgery.
Discussion:

► Thyroid nodules are very common with 50% of people over fifty years
having thyroid nodules on ultrasound.
► Thyroid nodules under 1 cm in size do not need to be investigated
with thyroid scans, ultrasounds, blood tests, or fine needle aspiration
biopsy (FNAB).
► While there is good evidence that the accuracy of this technique is
improved when the FNAB is coupled with ultrasound.
► I must say it is important to follow up on a benign hot nodule to
prevent malignancies.
Conclusion:

► Thyroid ultrasonography is the recognized "gold standard" for an

accurate and reliable assessment of gland volume and thyroid
nodules.
► Ultrasound-guided FNAB is the best investigation for patients with
nodules greater than 1cm in size. Nodules less than this size can be
watched.
► The patient has an autonomous functioning thyroid nodule and was
referred for radioiodine therapy.
References:

► http://www.sgsnuclearmedicine.com.au/images/
case_studies/10_Young_women_thyroid_nodule.pdf
► https://www.endocrineweb.com/conditions/thyroid-nodules