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11-29-2009, 09:48 AM
SOLITARY THYROID NODULE
Definition: Single nodule in otherwise normal thyroid gland
Causes:
[1] Metabolic nodule "colloid adenoma"
[2] True adenoma.
[3] Toxic nodule.
[4] Malignant nodule.
Diagnosis:
I. Clinical picture:
1- Manifestations of toxicity « toxic nodule. (See before)
2- Manifestations of suggesting malignancy « Malignant nodule. (see before)
3- If there is no symptoms suggesting malignancy or toxicity \ « Metabolic adenoma or true adenoma are suspected.
II- Scintillation scanning:
1- Hot nodule «Toxic nodule.
2- Cold nodule « Metabolic, true adenoma or malignant nodule.
III- Ultrasonography:
1- Cyst « with benign conditions.
2- Solid « May be benign or malignant.
IV- If malignancy is suspected biopsy may be needed:
1- Fine needle aspiration cytology with high accuracy in skilled hands.
2- Frozen section "Intraoperative"
Treatment:
1- Hemithyroidectomy = isthmus and one lobe
─ Indicated only in true adenoma
─ We remove the isthmus as it is a common site of recurrence.
2- Subtotal thyroidectomy:
─ Indicated in colloid & toxic nodule.
3- Total thyroidectomy indicated in malignant nodule.
─Operation: Preoperative preparation and operative details. (see before)
SOURCE: Prof. AYMAN SALEM'S BOOK
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