Clinical Diagnostic Approach for Cases of Thyroid Nodules
Clinical Diagnostic Approach for Cases of Thyroid Nodules
Thyroid nodules are a common presentation in the clinic, with an increasing incidence,
 especially in women. Their clinical significance is mainly related to excluding malignancy
 (4.0 to 6.5% of all thyroid nodules).
Thyroid nodule is a discrete lesion in the thyroid gland that is radiologically distinct from
 the surrounding thyroid parenchyma.

 Thyroid nodules are a common presentation in the clinic, with an increasing incidence,
 especially in women. The detection rate among healthy individuals is as high as 50%-60%, but
 the reported incidence of malignant nodules in all thyroid nodules has ranged from only
 1.6%-12%.

 They are discovered either clinically on self-palpation by a patient, or during a physical
 examination by the clinician or incidentally during a radiologic procedure such as
 ultrasonography (US) imaging, computed tomography (CT) or magnetic resonance imaging (MRI) of
 the neck; with the increased use of sensitive imaging techniques, thyroid nodules are being
 diagnosed incidentally with increasing frequency in the recent years.

 Though thyroid nodules are common, their clinical significance is mainly related to excluding
 malignancy (4.0 to 6.5% of all thyroid nodules), evaluating their functional status and if
 they cause pressure symptoms.

 Thyroid nodules can be caused by many disorders:

 Benign (colloid nodule, Hashimoto's thyroiditis, simple or hemorrhagic cyst, follicular
 adenoma and subacute thyroiditis) and malignant (Papillary Cancer, Follicular Cancer, Hurthle
 Cell Cancer, Anaplastic Cancer, Medullary Cancer, Thyroid Lymphoma and metastases).

 Initial assessment of a patient found to have a thyroid nodule either clinically or
 incidentally should include a detailed and relevant history plus physical examination.
 Laboratory tests should begin with measurement of serum thyroid-stimulating hormone (TSH).
 Thyroid scintigraphy/radionuclide thyroid scan should be performed in patients presenting
 with a low serum TSH.

 Thyroid ultrasound should be performed in all those suspected or known to have a nodule to
 confirm the presence of a nodule, evaluate for additional nodules and cervical lymph nodes
 and assess for suspicious sonographic features.

 The next step in the evaluation of a thyroid nodule is a fine needle aspiration (FNA) biopsy,
 which is the gold standard diagnostic test.
Inclusion Criteria:

 -  all patient presented by thyroid nodules either discovered clinically or incidentally.

 Exclusion Criteria:

 -  no