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Thyroid adenoma diagnostic study of choice

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Roukoz A. Karam, M.D.[2] Ammu Susheela, M.D. [3]

Overview

Overview

There is no single diagnostic study of choice for the diagnosis of thyroid adenoma, but thyroid nodules can be diagnosed based on an ultrasound examination of the neck, a screening serum TSH level, and fine needle aspiration biopsy.

Diagnostic Study of Choice

Diagnostic Study of Choice

Study of choice

  • There is no single diagnostic study of choice for the diagnosis of thyroid adenoma, but thyroid nodules can be diagnosed based on an ultrasound examination of the neck, a screening serum TSH level, and fine needle aspiration biopsy.
  • Thyroid function tests should be assessed in all patients with thyroid nodules as the primary diagnostic step in all patients with a neck mass.
  • Fine needle aspiration biopsy remains the most important diagnostic modality for evaluating patients with a thyroid nodule. A major limitation of fine needle aspiration biopsy, however, is the inability to distinguish a follicular adenoma from a follicular carcinoma.

Biopsy

Key Biopsy Findings in Thyroid adenoma

  • Areas of hemorrhage, fibrosis, calcification, and cystic change are common in thyroid (follicular) adenoma, particularly in larger lesions.
  • Encapsulated tumors do not have any evidence of infiltration.
  • Colloid nodules are distinguished by an apparently gelatinous mass of colloid both surrounding and contained within follicular cells.
  • Colloid nodules are not surrounded by a fibrous capsule of compressed tissue; however, they are surrounded by flattened epithelial cells. Both the number of cells and the type of colloid may vary considerably.[3]


 
 
 
 
 
 
 
 
 
 
 
 
 
A patient with thyroid nodule
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Normal thyroid stimulating hormone
 
 
 
 
 
 
 
Low thyroid stimulating hormone
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
<1cm suspicious nodule
 
 
>1cm nodule
 
 
 
 
 
Thyroid nuclear scan
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ultrasound guided fine needle aspiration cytology
 
 
Fine needle aspiration cytology
 
 
 
Hot nodule
 
 
 
Cold nodule
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fine needle aspiration cytology
 
 
 
 
 
 
 
 
References

References

  1. Hamberger, B (1982). “Fine-needle aspiration biopsy of thyroid nodules. Impact on thyroid practice and cost of care”. Am J Med. 73 (3): 381–384. doi:10.1016/0002-9343(82)90731-8. PMID 7124765.
  2. Mazzaferri (1993). “Management of a Solitary Thyroid Nodule”. N Engl J Med. 328 (8): 553–9. doi:10.1056/NEJM199302253280807. PMID 8426623.
  3. Diana S. Dean, M.D. Hossein Gharib, M.D. (10 October 2010). “Fine-Needle Aspiration Biopsy of the Thyroid Gland, Chapter 6d”. thyroidmanager.org. Retrieved 26 September 2011.

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