General Surgery Residency Program, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
S D Med. 2022 Dec;75(12):569-572.
Thyroid nodules are exceedingly common in the general population and their increasing incidence appears to be secondary to incidental finding on imaging. Nonetheless, due to the potential for malignancy and thyroid dysfunction, most thyroid nodules require further investigation. Although there are no current guidelines for thyroid cancer screening in asymptomatic patients, a thorough history and physical which focuses on risk factors can serve as a good starting point during the evaluation of a thyroid nodule. This is followed by diagnostic analysis with thyroidstimulating hormone; as well as thyroid scintigraphy, T4, and T3 when indicated. Ultrasound is the gold standard diagnostic imaging modality for suspicious thyroid nodules and can provide further information on malignancy potential and the need for fine need aspiration (FNA). Thyroid nodules can then be further classified on a spectrum ranging from benign to malignant based on a combination of ultrasound and FNA findings. Patients with thyroid nodules that are malignant, suspicious for malignancy, or intermediate lesions should be referred on to a surgeon for potential operative intervention. It is important for primary care providers to be well versed in the work-up and initial evaluation of thyroid nodules as they are often the first provider a patient will present to. This review article serves to refresh and guide the primary care provider through the initial evaluation and management of thyroid nodules.
甲状腺结节在普通人群中非常常见，其发病率的增加似乎是由于影像学偶然发现的结果。尽管如此，由于存在恶性肿瘤和甲状腺功能障碍的潜在风险，大多数甲状腺结节需要进一步检查。虽然目前没有无症状患者的甲状腺癌筛查指南，但全面的病史和体格检查，重点关注危险因素，可以作为评估甲状腺结节的良好起点。接下来是甲状腺刺激激素的诊断分析;以及在需要时进行甲状腺闪烁显像、T4 和 T3。超声是可疑甲状腺结节的金标准诊断成像方式，可提供关于恶性肿瘤潜力和细针抽吸 (FNA) 必要性的进一步信息。然后，根据超声和 FNA 检查结果，甲状腺结节可以在从良性到恶性的范围内进一步分类。对于恶性、疑似恶性或中间病变的甲状腺结节患者，应转介给外科医生进行潜在的手术干预。初级保健提供者熟悉甲状腺结节的检查和初步评估非常重要，因为他们通常是患者首先就诊的提供者。本文综述旨在为初级保健提供者提供甲状腺结节的初步评估和管理方面的更新和指导。
