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Abstract
In this Thyroid Section, we have presented several cases and clinical scenarios that are commonly encountered by clinicians. Drs. Chindris and Bernet describe a patient with a recently discovered thyroid nodule. Thyroid nodules are frequent and by autopsy study occur in about 12–37 % of individuals with 2.1 % having thyroid cancer [1]. The important issue is how to discriminate a thyroid nodule that is likely to be benign that can be monitored from a nodule more likely to harbor malignancy and should be more aggressively treated with thyroid surgery. Clinical history and features play an important role in this discrimination with, for example, a history of neck radiation, a family history of thyroid cancer, and local compression symptoms being worrisome for the presence of thyroid cancer [2]. Thyroid ultrasound characteristics are also important with shape (taller than wide), hazy borders, hypoechogenicity, increased internal vascularity, and microcalcifications suggesting (but not proving) the presence of thyroid cancer [3]. Serum TSH in the upper portion of the normal range is statistically correlated with the presence of thyroid cancer [4]. Of course, the cornerstone of the diagnostic approach is the performance of a thyroid Fine Needle Aspiration (FNA) [2]. Drs. Chindris and Bernet discuss the interpretation of an FNA in detail, but, in general, a thyroid FNA will be interpreted as benign, indeterminate, or consistent with malignancy (usually papillary thyroid cancer). Benign nodules generally can be monitored (with some exceptions) and malignant nodules (e.g., papillary thyroid cancer) require a thyroidectomy. The approach to an indeterminate cytology has improved recently due to the ability to perform molecular diagnostics. The likelihood of an indeterminate nodule harboring cancer is about 5–15 % for Atypia of Undetermined Significance (AUS), 15–30 % for follicular lesion, and 60–75 % for suspicious for papillary thyroid cancer [5]. There are two available molecular diagnostic tests or approaches presently available that can assist in helping to determine if an indeterminate nodule contains cancer [5, 6]. Drs. Chindris and Bernet discuss the molecular analysis and its clinical applicability in detail. They also discuss the appropriate management and monitoring for each type of thyroid nodule.
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Authors and Affiliations
Endocrine Section, Medstar Washington Hospital Center, Washington, DC, USA
Kenneth D. Burman M.D.
Department of Medicine, Georgetown University, Washington, DC, USA
Kenneth D. Burman M.D.
- Kenneth D. Burman M.D.
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Correspondence toKenneth D. Burman M.D..
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Editors and Affiliations
Div. Endocrinology, Diabetes & Bone Disease, Mount Sinai School of Medicine Dept. Medicine, New York, New York, USA
Terry F. Davies
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Burman, K.D. (2015). Introduction. In: Davies, T. (eds) A Case-Based Guide to Clinical Endocrinology. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2059-4_14
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