الفهرس 
DEVELOPMENT OF THYROIDOnly 14 pages are availabe for public view
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Abstract
Thyroid nodules are very common in the general population, while thyroid cancer is relatively uncommon. The goal of the evaluation of the thyroid nodule is to identify and surgically treat patients with malignancies, while identifying and avoiding surgery in those with benign, asymptomatic thyroid nodules.
Nodules are found through physical examination or incidentally through imaging modalities performed for other reasons.
The evaluation of the thyroid nodule begins with patient history, risk factor assessment, and physical exam.
All patients with a thyroid nodule should undergo cervical ultrasonography and have serum TSH measured.
Further diagnostic evaluation is done by FNA biopsy of thyroid nodules which has become one of the most useful, safe, and accurate tools in the diagnosis of thyroid pathology. Thyroid nodules that should be considered for FNA include any firm, palpable, solitary nodule or nodule associated with worrisome clinical features (rapid growth, attachment to adjacent tissues, hoarseness, or palpable lymphadenopathy).
FNA should also be performed on nodules with suspicious ultrasonographic features (microcalcifications, rounded shape, predominantly solid composition); dominant or atypical nodules in multinodular goiter; complex or recurrent cystic nodules; or any nodule associated with palpable or ultrasonographically abnormal cervical lymph nodes.
Finally, FNA should be performed on any abnormal- appearing or palpable cervical lymph nodes.
Multiple diagnostic categories for FNA biopsies of thyroid nodules have been developed, each with its own risk of malignancy.
Many potential molecular markers have been studied to improve the accuracy of FNAB and have shown great promise in their ability to detect malignancy in FNAB specimens particularly those indeterminate or suspicious biopsies. Two markers, thyroid peroxidase and galectin-3, seem to be particularly promising as practical tools to improve the accuracy of FNAB. These markers accurately distinguish benign from malignant thyroid nodules, even in the subset of cytologically indeterminate FNABs.
Benign asymptomatic small thyroid nodules can be observed in low-risk patients. Large thyroid nodule, or FNA results classified as “malignant,” “suspicious for malignancy,” or “indeterminate” should prompt surgical excision. Small, asymptomatic nodules classified as “follicular lesions of undetermined significance” require at least a repeat FNA biopsy. Thyroid nodules that cause compressive symptoms should be treated surgically, while autonomously functioning (“hot”) thyroid nodules may be treated with radioactive iodine ablation or surgery depending on the clinical scenario.