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- • Ultrasound is a safe and simple way of determining if a mass is solid or filled with fluid (cystic). It can also
- detect multiple nodules where only one may be felt. High-resolution ultrasound can find nodules as small as
- 3mm in diameter. It cannot distinguish benign from malignant tumors. Since it is non-invasive and sensitive, it
- is the most accurate way to measure and follow a suspicious nodule in a patient given thyroid hormone in an
- attempt to suppress the nodule. It may also be used to guide biopsy procedures.
- • Standard x-rays, such as chest x-ray to look for metastases.
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- Endoscopy and Biopsy
- • Indirect or direct laryngoscopy if there is hoarseness, difficulty swallowing, coughing of blood (hemoptysis),
- shortness of breath or if the patient has had a previous neck operation.
- • Fine needle aspiration (FNA) biopsy is the initial step in evaluating thyroid nodules in patients who do not
- have a history of exposure to low-dose radiation therapy , as it provides more information than any other
- diagnostic technique. It is over 90 percent accurate for benign lesions and about 99 percent accurate for
- malignancies. FNA is not recommended for those with a history of radiation therapy because they usually
- have many nodules, only 40 percent have cancer, and the wrong nodule may be aspirated.
- FNA is also very useful in selecting patients for surgery. Only about 3 percent of patients with benign
- findings on FNA will have thyroid cancer, so surgery can be postponed in these patients while the thyroid
- suppression trial is done. The TSH level must be suppressed by the dosage of thyroid hormone. If the nodule
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