Tiroid Nodüllerine Klinik Yaklaşım
Özet
Tiroid nodülü, tiroid bezi içinde yapısal değişiklik sonucu oluşan ve çevresinden yapı ve içerik olarak farklı yapıda olan yuvarlak veya oval oluşumlardır. Büyük bir çoğunluğu benign karakterde olup ve asemptomatiktir. Nodül saptanması durumunda tiroid stimulan hormon (TSH) ölçümü yapılması gerekmektedir. Eğer TSH değeri düşük saptanırsa serbest T3 ve T4 ölçülmelidir. TSH değeri yüksekse serbest T4 ölçülüp santral hipotiroidi dışlanınca, kronik tiroidit tanısı açısından antitiroid peroksidaz antikoru (anti-TPO) ölçülmelidir. Anti-tiroglobulin antikoru ise anti-TPO normal olanlarda ölçülmelidir. Tiroglobulin ölçmenin yararı yoktur. Kalsitonin düzeyinin rutin olarak ölçülmesi hala tartışmalıdır. Ultrasonografik olarak değerlendirilip kriterleri uygun olan nodüllere ince iğne aspirasyon biyopsisi yapılması gerekmektedir.
Referanslar
Haugen BR, Alexander EK, Bible KC, American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;26(1):1-133. [ PubMed: 26462967]
Pemayun TG. Current Diagnosis and Management of Thyroid Nodules. Acta Med Indones. 2016 Jul;48(3):247-257. [ 3. 4. 5. PubMed: 27840362]
Bomeli SR, LeBeau SO, Ferris RL. Evaluation of a thyroid nodule. Otolaryngol Clin North Am. 2010 Apr;43(2):229-38, vii. [ PubMed: 20510711]
Durante C, Costante G, Lucisano G, The natural history of benign thyroid nodules. JAMA. 2015 Mar 03;313(9):926-35. [ PubMed: 25734734] 7/9 https://www.ncb.nlm.nh.gov/books/NBK535422/ 21.01.2024 08:04 Thyrod Nodule - StatPearls - NCBI Bookshelf
Popoveniuc G, Jonklaas J. Thyroid nodules. Med Clin North Am. 2012 Mar;96(2):329-49.[ 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. PubMed: 22443979]
Welker MJ, Orlov D. Thyroid nodules. Am Fam Physician. 2003 Feb 01;67(3):559-66. [PubMed: 12588078]
Yeung MJ, Serpell JW. Management of the solitary thyroid nodule. Oncologist. 2008 Feb;13(2):105-12. [ PubMed: 18305054]
Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab. 2008 Dec;22(6):901-11. [ PubMed: 19041821]
Cohen A, Rovelli A, Merlo DF. Risk for secondary thyroid carcinoma after hematopoietic stem-cell transplantation: an EBMT Late Effects Working Party Study. J Clin Oncol. 2007 Jun 10;25(17):2449-54. [ PubMed: 17557958]
Vanderpump MP, Tunbridge WM, French JM, The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf). 1995 Jul;43(1):55-68. [ PubMed: 7641412]
Belfiore A, La Rosa GL, La Porta GA. Cancer risk in patients with cold thyroid nodules: relevance of iodine intake, sex, age, and multinodularity. Am J Med. 1992 Oct;93(4):363-9. [ PubMed: 1415299]
Kameyama K, Ito K, Takami H. [Pathology of benign thyroid tumor]. Nihon Rinsho. 2007 Nov;65(11):1973-8. [ PubMed: 18018557]
Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med. 1993 Feb 25;328(8):553-9. [ PubMed: 8426623]
Saad AG, Kumar S, Ron E, Proliferative activity of human thyroid cells in various age groups and its correlation with the risk of thyroid cancer after radiation exposure. J Clin Endocrinol Metab. 2006 Jul;91(7):2672-7. [PubMed: 16670159]
Bounacer A, Wicker R, Caillou B. High prevalence of activating ret proto-oncogene rearrangements, in thyroid tumors from patients who had received external radiation. Oncogene. 1997 Sep;15(11):1263-73. [PubMed: 9315093]
Cibas ES, Ali SZ. The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2017 Nov;27(11):1341-1346. [ PubMed: 29091573]
Baloch ZW, LiVolsi VA, Asa SL. Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: a synopsis of the National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Diagn Cytopathol. 2008 Jun;36(6):425 37. [ PubMed: 18478609]
Nikiforov YE, Seethala RR, Tallini G, Nomenclature Revision for Encapsulated Follicular Variant of Papillary Thyroid Carcinoma: A Paradigm Shift to Reduce Overtreatment of Indolent Tumors. JAMA Oncol. 2016 Aug 01;2(8):1023-9. [PubMed: 27078145]
Walfish PG, Strawbridge HT, Rosen IB. Management implications from routine needle biopsy of hyperfunctioning thyroid nodules. Surgery. 1985 Dec;98(6):1179-88. [ PubMed: 20. 21. 4071393]
Gharib H, Papini E. Thyroid nodules: clinical importance, assessment, and treatment. Endocrinol Metab Clin North Am. 2007 Sep;36(3):707-35. [ PubMed: 17673125]
Alexander EK, Heering JP, Benson CB. Assessment of nondiagnostic ultrasound-guided fine needle aspirations of thyroid nodules. J Clin Endocrinol Metab. 2002 Nov;87(11):4924-7. [ 22. 23. 24. 25. PubMed: 12414851]
Singh RS, Wang HH. Timing of repeat thyroid fine-needle aspiration in the management of thyroid nodules. Acta Cytol. 2011;55(6):544-8. [ PubMed: 22156464]
Alvi A, Johnson JT. The neck mass. A challenging differential diagnosis. Postgrad Med. 1995 May;97(5):87-90, 93-4, 97. [ PubMed: 7753749]
Lin ST, Tseng FY, Hsu CJ. Thyroglossal duct cyst: a comparison between children and adults. Am J Otolaryngol. 2008 Mar-Apr;29(2):83-7. [ PubMed: 18314017]
Gluckman JL, Robbins KT, Fried MP. Cervical metastatic squamous carcinoma of unknown or occult primary source. Head Neck. 1990 Sep-Oct;12(5):440-3. [PubMed: 2211107]
Tuttle RM. Risk-adapted management of thyroid cancer. Endocr Pract. 2008 Sep;14(6):764 74. [ PubMed: 18996800]
Eustatia-Rutten CF, Corssmit EP, Biermasz NR. Survival and death causes in differentiated thyroid carcinoma. J Clin Endocrinol Metab. 2006 Jan;91(1):313-9. [ PubMed: 16263822]
Leboulleux S, Rubino C, Baudin E. Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and/or tumor extension beyond the thyroid capsule at initial diagnosis. J Clin Endocrinol Metab. 2005 Oct;90(10):5723-9. [ PubMed: 16030160]
Grebe SK, Hay ID. Follicular thyroid cancer. Endocrinol Metab Clin North Am. 1995 Dec;24(4):761-801. [ PubMed: 8608779]
Tan GH, Gharib H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med. 1997 Feb 01;126(3):226-31. [ PubMed: 9027275]
Schneider AB, Sarne DH. Long-term risks for thyroid cancer and other neoplasms after exposure to radiation. Nat Clin Pract Endocrinol Metab. 2005 Dec;1(2):82-91. [ PubMed: 16929376]
Referanslar
Haugen BR, Alexander EK, Bible KC, American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;26(1):1-133. [ PubMed: 26462967]
Pemayun TG. Current Diagnosis and Management of Thyroid Nodules. Acta Med Indones. 2016 Jul;48(3):247-257. [ 3. 4. 5. PubMed: 27840362]
Bomeli SR, LeBeau SO, Ferris RL. Evaluation of a thyroid nodule. Otolaryngol Clin North Am. 2010 Apr;43(2):229-38, vii. [ PubMed: 20510711]
Durante C, Costante G, Lucisano G, The natural history of benign thyroid nodules. JAMA. 2015 Mar 03;313(9):926-35. [ PubMed: 25734734] 7/9 https://www.ncb.nlm.nh.gov/books/NBK535422/ 21.01.2024 08:04 Thyrod Nodule - StatPearls - NCBI Bookshelf
Popoveniuc G, Jonklaas J. Thyroid nodules. Med Clin North Am. 2012 Mar;96(2):329-49.[ 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. PubMed: 22443979]
Welker MJ, Orlov D. Thyroid nodules. Am Fam Physician. 2003 Feb 01;67(3):559-66. [PubMed: 12588078]
Yeung MJ, Serpell JW. Management of the solitary thyroid nodule. Oncologist. 2008 Feb;13(2):105-12. [ PubMed: 18305054]
Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab. 2008 Dec;22(6):901-11. [ PubMed: 19041821]
Cohen A, Rovelli A, Merlo DF. Risk for secondary thyroid carcinoma after hematopoietic stem-cell transplantation: an EBMT Late Effects Working Party Study. J Clin Oncol. 2007 Jun 10;25(17):2449-54. [ PubMed: 17557958]
Vanderpump MP, Tunbridge WM, French JM, The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf). 1995 Jul;43(1):55-68. [ PubMed: 7641412]
Belfiore A, La Rosa GL, La Porta GA. Cancer risk in patients with cold thyroid nodules: relevance of iodine intake, sex, age, and multinodularity. Am J Med. 1992 Oct;93(4):363-9. [ PubMed: 1415299]
Kameyama K, Ito K, Takami H. [Pathology of benign thyroid tumor]. Nihon Rinsho. 2007 Nov;65(11):1973-8. [ PubMed: 18018557]
Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med. 1993 Feb 25;328(8):553-9. [ PubMed: 8426623]
Saad AG, Kumar S, Ron E, Proliferative activity of human thyroid cells in various age groups and its correlation with the risk of thyroid cancer after radiation exposure. J Clin Endocrinol Metab. 2006 Jul;91(7):2672-7. [PubMed: 16670159]
Bounacer A, Wicker R, Caillou B. High prevalence of activating ret proto-oncogene rearrangements, in thyroid tumors from patients who had received external radiation. Oncogene. 1997 Sep;15(11):1263-73. [PubMed: 9315093]
Cibas ES, Ali SZ. The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2017 Nov;27(11):1341-1346. [ PubMed: 29091573]
Baloch ZW, LiVolsi VA, Asa SL. Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: a synopsis of the National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Diagn Cytopathol. 2008 Jun;36(6):425 37. [ PubMed: 18478609]
Nikiforov YE, Seethala RR, Tallini G, Nomenclature Revision for Encapsulated Follicular Variant of Papillary Thyroid Carcinoma: A Paradigm Shift to Reduce Overtreatment of Indolent Tumors. JAMA Oncol. 2016 Aug 01;2(8):1023-9. [PubMed: 27078145]
Walfish PG, Strawbridge HT, Rosen IB. Management implications from routine needle biopsy of hyperfunctioning thyroid nodules. Surgery. 1985 Dec;98(6):1179-88. [ PubMed: 20. 21. 4071393]
Gharib H, Papini E. Thyroid nodules: clinical importance, assessment, and treatment. Endocrinol Metab Clin North Am. 2007 Sep;36(3):707-35. [ PubMed: 17673125]
Alexander EK, Heering JP, Benson CB. Assessment of nondiagnostic ultrasound-guided fine needle aspirations of thyroid nodules. J Clin Endocrinol Metab. 2002 Nov;87(11):4924-7. [ 22. 23. 24. 25. PubMed: 12414851]
Singh RS, Wang HH. Timing of repeat thyroid fine-needle aspiration in the management of thyroid nodules. Acta Cytol. 2011;55(6):544-8. [ PubMed: 22156464]
Alvi A, Johnson JT. The neck mass. A challenging differential diagnosis. Postgrad Med. 1995 May;97(5):87-90, 93-4, 97. [ PubMed: 7753749]
Lin ST, Tseng FY, Hsu CJ. Thyroglossal duct cyst: a comparison between children and adults. Am J Otolaryngol. 2008 Mar-Apr;29(2):83-7. [ PubMed: 18314017]
Gluckman JL, Robbins KT, Fried MP. Cervical metastatic squamous carcinoma of unknown or occult primary source. Head Neck. 1990 Sep-Oct;12(5):440-3. [PubMed: 2211107]
Tuttle RM. Risk-adapted management of thyroid cancer. Endocr Pract. 2008 Sep;14(6):764 74. [ PubMed: 18996800]
Eustatia-Rutten CF, Corssmit EP, Biermasz NR. Survival and death causes in differentiated thyroid carcinoma. J Clin Endocrinol Metab. 2006 Jan;91(1):313-9. [ PubMed: 16263822]
Leboulleux S, Rubino C, Baudin E. Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and/or tumor extension beyond the thyroid capsule at initial diagnosis. J Clin Endocrinol Metab. 2005 Oct;90(10):5723-9. [ PubMed: 16030160]
Grebe SK, Hay ID. Follicular thyroid cancer. Endocrinol Metab Clin North Am. 1995 Dec;24(4):761-801. [ PubMed: 8608779]
Tan GH, Gharib H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med. 1997 Feb 01;126(3):226-31. [ PubMed: 9027275]
Schneider AB, Sarne DH. Long-term risks for thyroid cancer and other neoplasms after exposure to radiation. Nat Clin Pract Endocrinol Metab. 2005 Dec;1(2):82-91. [ PubMed: 16929376]
