12 responses to “Thyroid Nodules: Get more information from your ultrasound”

  1. I learnt use of ultrasound in distinguishing malignant nodules.

  2. This is a nice overview of how to investigate thyroid nodules,although this is not a common issue in my practice.

  3. useful and concise presentation
    it would be nice to have a comment on whether multi nodular thyroids need regular US reassessment and if so, how often

  4. Useful info and practical

  5. Seeing a functioning or hyperfunctioning nodule was, I thought, somewhat reassuring regarding increased likelihood of being benign. Hence, I was wondering if a normal TSH always negates the benefit of a radionucleide screen. Is it not possible to have a nodule that is even slightly hyperfunctioning but not enough to suppress TSH?

  6. Good job. Keep going

  7. concise summary of guidelines

  8. Thank you all for your feedback.

    You are right. Seeing a hyperfunctioning nodule is reassuring as it is most likely benign. However, in order to ensure a nodule is hyperfunctioning, one needs to confirm that a suppressed TSH corresponds with a hyperfunctioning nodule on a radionuclide scan.
    Current American Thyroid Association’s guidelines recommend that a follow up ultrasound be done whenever the TSH is normal. Most thyroid malignancies tend to be euthyroid.
    Reference: http://thyroidguidelines.net/revised/nodules

    Moreover, the risk of malignancy is independent of the number of nodules present. Rather it is the ultrasound characteristics of the nodule that dictate whether it needs to be biopsied (see above).
    Again, for benign nodules after the initial FNA, ATA guidelines recommend an ultrasound every 6-18 months. They further indicate that if the nodule is “stable” (i.e., <50% change in volume or <20% increase in at least two nodule dimensions in solid nodules or in the solid portion of mixed cystic–solid nodules), the interval before the next follow-up clinical examination or US may be longer, e.g., every 3–5 year.

  9. I have been doing all those described. However there were still the occasional situation where a “cold” nodule of >1.5 cm, neither purely hypo- or hyper-echoic, and the FNA cytology were “indeterminate” that I had finaly had to do a lobectomy and frozen section to determine the actual pathology.

  10. I just found this great information online it’s all about detailed descriptions with images of common benign and cancerous ultrasound thyroid features. It’s by radiologist Dr.Jill Langer from University of Penn. The last date of one of her references was from 2010. It says that taller than wide shape is more common with thyroid cancers under 10mm.


  11. If nodule is cold or greater than 1 centimeter then examine of Cancer can be done by FNAC.

  12. What about 3 new additional nodules described by a radiologist as low-density with increased blood flow? The sizes were reported, but not the shape. I’ve sent the request for that information. Would that indicate a FNA or monitoring?

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