History taking
Thyroid function tests (free T3, free T4 and TSH)
Other laboratory tests (antimicrosomal antibodies, thyroglobulin)
Thyroid ultrasonography
Thyroid gland scintigraphy
Fine needle aspiration biopsy
Many of the symptoms of thyroid gland diseases are non-specific complaints. Patients with goiter often have symptoms such as difficulty swallowing, difficulty breathing and a feeling of suffocation. Pain is not a common complaint. Voice change is a symptom that should be carefully considered in the anamnesis. Information such as having a family history of benign or malignant thyroid gland disease, previous exposure to radiation, living in an area where goiter is endemic, or use of goitrogenic drugs should also be taken into consideration when taking anamnesis.
Examination of the thyroid gland begins with observation. . Enlargement of the thyroid gland or some of the thyroid masses can be easily detected because they move with swallowing. Unless the patient has a weak neck, normal thyroid tissue is usually not palpable. Lastly, the neck lymph nodes should also be evaluated.
Thyroid function tests should be checked in every patient. Laboratory tests such as antimicrosomal antibodies (in autoimmune diseases such as Graves) and thyroglobulin level (in postoperative follow-up due to thyroid cancer) are needed in more specific cases.
Thyroid ultrasonography is very useful in diagnosis. It allows us to evaluate the size and structure of the thyroid gland, if there is a nodule, whether it is solid or cystic, and its diameter. It is also used to monitor nodule diameter and sometimes to guide needle biopsy.
Thyroid scintigraphy is especially useful in hyperthyroidism (toxic goiter). It shows the widespread increase in activity in the thyroid gland or the activity of nodules.
In some cases, computed tomography may also be needed (to show whether complaints such as shortness of breath or difficulty swallowing are really due to thyroid gland compression).
Thyroid fine needle aspiration biopsy is an examination with a high accuracy rate of 95% in the evaluation of thyroid nodules. It can be performed by a clinician or a radiologist with ultrasonography guidance. Approach to thyroid nodules is a very important aspect in deciding whether to follow up or operate. �but. When the fine needle biopsy result is suspicious or malignant, surgery is inevitable. If unsatisfactory results are obtained, the procedure must be repeated. If the result shows that it is a benign nodule and other parameters (nodule size, structure, relationship with surrounding tissues, etc.) are not suspicious, then a decision can be made to follow up for a while before surgery is required.
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