Section 3 Nodular Goiter

*Goiter - Causes and Treatment*

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**Chapter 6**

**Abstract**

available.

**1. Introduction**

included to cover this area include

the ACR TI-RADS Committee [3].

Management

*and Mahendra Kumar Garg*

Thyroid Nodule: Approach and

*Madhukar Mittal, Vanishri Ganakumar, Ravindra Shukla* 

A thyroid nodule is a discrete radiologically distinct lesion in the gland parenchyma. These are a common finding in the general population, majority being diagnosed incidentally during neck imaging. The major clinical relevance lies in the fact that 4–6.5% of nodules can be malignant. A thorough clinical evaluation and examination should be followed by serum TSH assessment and ultrasonography for assessment of size, number, imaging characteristics suggestive of malignancy, cervical lymphadenopathy. FNA should be done based on clinical and sonographic characteristics. Further choice of management modality and extent of surgery should be based on cytopathological findings supplemented by molecular testing if

**Keywords:** thyroid nodule, toxic adenoma, multinodular goitre, thyroiditis

A thyroid nodule is defined as a discrete radiologically distinct lesion from the

1.The 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer.

2.AACE/ACE/AME Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the

3.ACR Thyroid Imaging, Reporting and Data System (TI-RADS): white paper of

diagnosis and management of thyroid nodules-2016 update [2].

surrounding thyroid parenchyma. Nodules which are palpable but do not correspond to distinct abnormalities on ultrasound do not fall under this category [1]. Clinically they can be identified by the doctor on examination or even noticed by the patient themselves. With the increasingly popular use of neck imaging modalities, thyroid nodules are being commonly identified during these imaging studies. The clinical importance lies in excluding malignancy in a thyroid nodule, assessing functional status, associated with pain at appearance and compressive symptoms (if large) and accordingly decide the line of management. The key guidelines
