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An autonomous thyroid nodule or "hot nodule" is one that has thyroid function independent of the homeostatic control of the HPT axis (hypothalamic–pituitary–thyroid axis). According to a 1993 article, such nodules need to be treated only if they become toxic; surgical excision (thyroidectomy), radioiodine therapy, or both may be used. [33]
Some experts [13] recommend that nodules > 1 cm (unless the TSH is suppressed) or those with ultrasonographic features of malignancy should be biopsied by fine needle aspiration. Computed tomography is inferior to ultrasound for evaluating thyroid nodules. [14] Ultrasonographic markers of malignancy are: [15] solid hypoechoic appearance
Thyroid nodules that are detected by an imaging study but have not been previously detected or suspected clinically are considered to be ITNs. ITNs are one of the most common incidental findings on neck imaging. ITNs are reported in up to 25% of chest CT scans, and in 16–18 % of cervical region cross-sectional imaging, including CT and MRI scans.
Colloid nodules may be initially identified as an unspecified kind of thyroid nodule. Follow-up examinations typically include an ultrasound if it is unclear whether or not there really is a nodule present. Once the presence of a nodule has been confirmed, the determination of the kind of thyroid nodule is done by fine needle aspiration biopsy. [7]
Most people with thyroid cancer do not have symptoms at the time of diagnosis and thyroid nodules and thyroid cancer is usually found incidentally on imaging of the neck. [10] [14] Up to 65% of adults have small nodules in their thyroids, but typically under 10% of these nodules are found to be cancerous. [15]
Treatment of a thyroid nodule depends on many things including size of the nodule, age of the patient, the type of thyroid cancer, and whether or not it has spread to other tissues in the body. If the nodule is benign, patients may receive thyroxine therapy to suppress thyroid-stimulating hormone and should be reevaluated in six months. [2]
The mean radiation dose to an adult from a chest radiograph is around 0.02 mSv (2 mrem) for a front view (PA, or posteroanterior) and 0.08 mSv (8 mrem) for a side view (LL, or latero-lateral). [1] Together, this corresponds to a background radiation equivalent time of about 10 days. [2]
The thyroid gland is extremely painful, rigid, and swollen, which can be symmetrical or asymmetrical. [2] Approximately half of affected adolescents and two-thirds of adults have widespread thyroid gland involvement. [3] [5] Thyroid nodules are seen in one-fourth of adult patients. [6] The surrounding skin is occasionally warm and erythematous.