Thursday, 28 November 2013

Thyroid disease: Thyroid adenoma – The Diagnosis

Thyroid is one of the largest endocrine glands found in the neck, below the Adam’s Apple with the function of regulating the body use of energy, make of proteins by producing its hormones as a result of the stimulation of thyroid-stimulating hormone (TSH) produced by the anterior pituitary.
Thyroid disease is defined as a condition of malfunction of thyroid.
Thyroid adenoma is a benign tumor started in the layer of cell lined the inner surface of the thyroid gland. The disease are relatively common among adults living in the United States. According to the study by the Mayo Clinic and Mayo Foundation, there is a report of 4 patients described in whom a follicular carcinoma developed following thyroidectomy for a benign follicular neoplasm. Most thyroid nodules are Thyroid adenoma.
D.2. Diagnosis
After recording the past and present history and completing a physical exam, including searching the nodule in the surrounding tissue and abnormal lymph nodes nearby. The tests which your doctor orders may include
1. Blood test
The aim of the test is to the level of free T4 and thyroid stimulating hormone (TSH) levels. Circulating analytes used in the exploration of thyroid function are TSH and free thyroid hormones (FT4 and FT3). TSH is used as first line analysis in diagnosis because a normal value excludes almost always a thyroid dysfunction. However in the follow up of a treatment for hypo- or hyperthyroidism, free hormones are to be determined since TSH reaction is delayed and does not reflect precisely the restoration of euthyroidism. The measurement of anti-thyroperoxidase antibodies (anti-TPO) will show the presence of an autoimmune thyroiditis and that of thyroid stimulating antibodies (TSI) will establish the diagnosis of Graves’ disease. The measurement of circulating thyroglobulin has no place in the diagnostic of thyroid dysfunction nor in the evaluation of a goitre but it is now the golden standard in the follow up of patients with a differentiated thyroid cancer after surgery and radioiodine ablation in patients without antithyroglobulin antibodies, according to the Services de Diagnostic et de Traitement par Isotopes(25).
2. Echography and Thyroid scintigraphy
Echography is the first line examination to evaluate thyroid morphology. It shows tiny thyroid nodules and gives precious informations on their structure, as well as paremchymatous diffuse abnormalities associated with thyroiditis. Thyroid scintigraphy with 99mTc allows establishing the functional characteristics of thyroid nodules (warm or cold) and to precise the origin of a thyrotoxicosis (autonomous toxic nodule vs Graves-Basedow, sub acute or silent thyroiditis). Whole body scintigraphy is mandatory after radioiodine treatment with 131I in order to visualize possible metastasis and establish their avidity for iodine(25).
3. Ultrasonography
All ultrasound examinations for thyroid nodule should include a malignancy risk assessment based on the markedly hypoechoic nature of the nodule, presence of microcalcifications, ill-defined margins, nodule with shape taller than wide and intra-nodular hypervascularity at color Doppler. In patients with multinodular thyroid gland, precise nodule mapping is necessary to allow accurate follow-up of each nodule, correctly identify which nodule(s) is hyper functioning on iodine scan (if done) and guide fine needle aspiration (FNA) of suspicious nodules(26).
4. Fine-needle aspiration biopsy (FNA) and Core needle biopsies (CNBs)
The most commonly used diagnostic method for the preoperative diagnosis of thyroid nodules is ultrasound-guided fine-needle aspiration biopsy (FNA), which often yields non-diagnostic or non-definitive results and seldom produces definite malignant diagnoses. Core needle biopsies (CNBs) may be beneficial for the diagnosis of papillary thyroid carcinoma and other non-follicular thyroid lesions. CNB may be considered as an additional diagnostic procedure in cases with FNA suspicious for malignancy(27).
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