From the Research
A palpable chord in the context of thyroid nodules is a significant finding that warrants further evaluation to exclude malignancy, with the most recent and highest quality study suggesting that fine-needle aspiration should be performed for nodules ≥ 1.0 cm depending on clinical and sonographic risk factors for thyroid cancer 1. When examining a patient with a palpable thyroid nodule, it is essential to assess thyroid function, degree of and future risk of mass effect, and exclude thyroid cancer, which occurs in 7-15% of thyroid nodules. The evaluation should include clinical history and examination, serum thyroid stimulating hormone (TSH) measurement, and ultrasound.
- Key components of thyroid nodule assessment include:
- Clinical history and examination
- Serum TSH measurement
- Ultrasound
- Fine-needle aspiration (FNA) if indicated
- The presence of a palpable thyroid nodule may indicate a solitary hot nodule, a toxic multinodular goitre, or thyroiditis, and further evaluation with a thyroid scan with 99Tc may be necessary if the serum TSH is suppressed.
- The primary goal of evaluating a palpable thyroid nodule is to exclude malignancy, and fine-needle aspiration biopsy is the method of choice for determining whether malignancy is present 1.
- In cases where the FNA specimen is indeterminate, molecular analysis may be performed to better discriminate between benign and malignant nodules.
- Surgery is indicated for FNA findings of malignancy or indeterminate cytology when there is a high risk clinical context, and may also be indicated for suspicion of malignancy, larger nodules, especially with symptoms of mass effect, and in some patients with thyrotoxicosis 1.