Transcript

Lee Tetreault:

Welcome to Frequently Asked Questions from the session, Thyroid Disorders. We are joined by Dr. Lagari. Before we begin with these questions, doctor, would you be able to reiterate a few key pointers from today's session to our audience?

Dr. Lagari:  

Sure. Thyroid nodules, which is the topic of specifically that I'm going to be speaking about, is a very common clinical conundrum within primary care. The prevalence of thyroid nodules has increased dramatically over the last decade or more, and this is because of the increased frequency of radiologic imaging. So, today's session we'll primarily go over the diagnosis, the evaluation and management of these nodules.

Lee Tetreault:

Great, doctor. Let's get into some of these frequently asked questions. First, how common are thyroid nodules and how do you diagnose them?

Dr. Lagari:  

Thyroid nodules are incredibly common, as I mentioned already, because of the advent of increased frequency of imaging for other issues, we are detecting these nodules more and more frequently. Sometimes you will encounter a patient that has a more obvious palpable or visible mass in their neck, which will prompt evaluation, but a large part of the time these nodules are detected incidentally. The best way to evaluate these nodules after obtaining a serum TSH level, and assuming that the TSH level is within the normal range, is to perform a thyroid ultrasound.

Lee Tetreault:

What are important risk factors and radiologic features of thyroid nodules that warrant further evaluation?

Dr. Lagari:  

The most common and most important risk factors to ask for in patients that you're evaluating who have thyroid nodules is a family history of thyroid cancer and a history of exposure to radiation in any form.

Lee Tetreault:

What is the gold standard for assessment of nodules that warrant further assessment?

Dr. Lagari:  

So, in those patients that are deemed to be candidates for further evaluation based on the radiologic criteria, which include size typically larger than 1.5 cm and certain other characteristics, the best way to further evaluate these patients is with a fine needle aspiration biopsy.

Lee Tetreault:

Is levothyroxine therapy an effective modality to shrink thyroid nodules?

Dr. Lagari:  

The short answer to that is no, it used to be a common practice to prescribe levothyroxine to shrink thyroid nodules as a wave of managing them. It has been demonstrated that suppressing the TSH with levothyroxine can result in some shrinkage of the tumors, but this is not sustained, and the risk of suppressing TSH are far too great, and this practice is not recommended.

Lee Tetreault:

And lastly, what are some advances in the evaluation of indeterminate thyroid nodules?

Dr. Lagari:  

So recently, the field of thyroid cytology and management of thyroid nodules has expanded to include molecular marker evaluation for those nodules that have undergone cytology review and have been determined to be indeterminate. We have several types of molecular marker testing that can be used, the most common of which include Afirma and ThyroSeq for evaluation of these nodules in order to make the best determination whether patients should be sent for surgery.

Lee Tetreault:

This is great information, doctor. Thank you so much for your time today.

Dr. Lagari:  

Thank you.




Associated Content