In a patient presenting with a swelling of the thyroid, the radionuclide scan showed a cold nodule and the ultrasound showed a non cystic solid mass. The management of this patient would be:-
Ans. is 'b' i.e. Hemithyroidectomy .A discrete solid swelling of the thyroid is mostly treated surgically by hemithyroidectomy. Biopsy of the resected segment is performed and if carcinoma found a total or near total thyroidectomy is done.A cystic swelling is treated by aspiration and surgery is performed only if it recurs or cytology is suspicious of malignancy.A discrete thyroid swelling is:malignant in 15% of cases.a follicular adenoma in 30-40% of cases.remainder are non-neoplastic i.e. colloidal degeneration, cysts or thyroiditis.Thus most of the discrete thyroid swelling are non-neoplastic and benign, still surgery Is the mainstay of treatment because of the risk of leaving a malignant nodule.Role of Isotope scanAn isotope scan divides thyroid swellings into - 'Hot', 'Warm' and 'Cold' nodule.Hot rules out malignancy.Cold favours malignancy andWarm in equivocal.Even though cold nodule favours malignancy only a very small percentage of them (~ 15%) turn out to be malignant, so isotope scanning is of very little use in distinguishing between malignant and non-malignant swellings and is rather obsolete now.Eltroxin for TSH suppression is used only for a small number of cases. It is tried for 6-12 months. If the swelling regresses, well and good. If it does not surgery is performed.
Lobectomy
Hemithyroidectomy
Eltroxin
Radio Iodine therapy
Evaluation of a Thyroid Nodule