Thyroid Nodules: Diagnosis and Treatment | Dr. Subramanian Kannan

Dr Subramanian Kannan, Consultant, Endocrinology at Narayana Health City, Bommasandra, Bengaluru, discusses thyroid nodules.
Thyroid nodules have become a common issue, often detected incidentally during other medical imaging tests such as chest CT scans, carotid Doppler, MRI of the brain and neck, or PET CT scans. These incidental findings require careful evaluation and a patient-centric approach.
If you notice a swelling in your neck, your doctor will likely recommend a neck ultrasound after a clinical examination. Ultrasound is the best method to assess thyroid nodules and can help determine their cancer risk. The American College of Radiology TI-RADS scoring system is commonly used to evaluate this risk. A lower score indicates a lower risk, while a higher score indicates a higher risk.
Fine needle aspiration cytology (FNAC) may be needed if the nodule is larger than one centimetre. This procedure involves sampling the nodule with a fine needle guided by ultrasound. Experienced professionals must do this to ensure accurate results.
A cytopathologist examines the FNAC slides and categorises the nodules using the Bethesda cytology reporting system. Nodules can be classified as benign, malignant, or indeterminate. Indeterminate results require further analysis, which might involve repeating the FNAC or conducting mutation testing to check for specific thyroid cancer-related mutations.
In cases where the nodule remains indeterminate, surgery might be recommended to remove part or all of the thyroid.
Thyroid nodules are commonly found due to medical imaging. Proper evaluation involves a dedicated ultrasound, expert cytopathology, and sometimes mutation testing. Consulting with your endocrinologist or surgeon will help determine the best course of action for your thyroid nodule.
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