Lesions that are different from the surrounding thyroid parenchyma and can be separated radiologically are called thyroid nodules. While the frequency of palpable nodules is 3 - 7%, the frequency of clinically undetectable nodules detected by ultrasonography is reported to be 20 - 76%. Most nodules are found incidentally during imaging examination (ultrasonography). The incidence of nodules increases with age. In clinical practice, when a nodule is detected in the thyroid, the most feared fear is that it may be malignant. However, it should not be forgotten that most of these lesions are benign and the patient will simply be followed up after a good evaluation. Thyroid nodules can be single or multiple, solid, cystic or mixed, functional or non-functional.
When a thyroid nodule is detected, the most important approach is to determine whether the nodule is benign or malignant. The probability of malignancy occurring in nodules is 5%.
Factors That Increase the Risk of Malignancy in Nodules:
- Occurrence in childhood
- Male gender,
- New nodule over 45 years of age
- Rapid growth in the nodule
- Accompanying hoarseness
- Exposure to radiation or in childhood receiving radiotherapy to the neck
- Presence of thyroid cancer in the family
- Cold nodule in scintigraphy (The probability of malignancy in cold nodules reaches 15%, while the malignancy rate in hot nodules is <1%.) strong>
- Presence of a hard, fixed, large nodule with irregular borders on examination
- Risky ultrasonography appearance
Ultrasonography that increases the possibility of nodules being malignant findings:
- Large nodule (>4 cm),
- No halo,
- Irregular borders ,
- Risky lymph nodes in the neck,
- Hypoechogenic structure,
- Irregular borders,
- Microcalcifications,
- Mixed Increased blood flow within the nodule,
- The height of the nodule in the transverse position is greater than its width.
For which nodules should thyroid fine needle aspiration biopsy be performed?
Needle biopsy should be performed on all nodules in people who have a family history of thyroid cancer and who were exposed to radiotherapy or radiation in their childhood.
In pure cystic nodules, if there is no risky appearance on the cyst wall, biopsy is unnecessary. Type B cystscan be drained if they are large.
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