ENDOCRINE ROUNDS CASE 1
This is a case of a middle age lady from Kashmir who came with incidentally detected thyroid nodule. A thyroid ultrasound was done, a picture of which is shown below. Thyroid function tests were suggestive of Overt hypothyroidism.
Q Ultrasound Characteristics of this lesion show Benign or malignant etiology ?
1. Doppler shows peripheral vascularity with no central vascularity
2. No visible microcalcifications
3. It is isoechoic or hyperchoic compared to surrounding area (Mixed echogenicity)
4. Regular margins
5. Spongiform appearance
6. More wide than tall (Wider > Taller)
The lesion can be characterized as ‘Low suspicion’ according to ATA 2015 guidelines
Q. What does the FNAC show ?
Q. What is the next step for the patient ?
1. Levothyroxine for the Overt hypothyroidism and follow up after 6 weeks
2. For the nodule- Repeat ultrasound after 6 month- If there is growth of 20% in two axis or new suspicious imaging features- Consider Repeat FNAC
ENDOCRINECASES.COM 
I agree with the management plan. Within 6 weeks follow up, if nodule size increases in size while patient is on Levothyroxine, it will strongly suggest malignancy.
Though size does not determine malignancy, It is important to know to rule out any subjective errors ( more chances of false result if size is more than 4 cm. Consistency of nodule is also important to know for the accuracy of sampling.
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