29 year old lady presented with a lump in her neck. Ultrasound showed a solitary nodule in her right thyroid gland. The nodule is hypoechoic and measures 7mm in diameter. On colour Doppler, there is increased vascularity, indicating that this is a functioning nodule. The rest of her thyroid gland is normal. Final diagnosis is solitary thyroid functioning nodule. He was referred back to the GP for thyroid function test.
In cases of thyroid nodules, when do we refer to a surgeon?
· Single, non-functioning nodule. Non-functioning means it is ‘avascular’ on ultrasound scan or ‘cold’ on Iodine scan. Biopsy is required to rule out malignancy.
· Dominant nodule in MNG (multi-nodular goitre). Dominant means there is one nodule that is significantly larger than the others. Similarly, biopsy is required to rule out malignancy.
· Compressive symptoms. When patient complains of difficulty breathing, surgery is indicated.
· Toxic nodule. Toxic means it is ‘hyper-vascular’ on ultrasound scan or ‘hot’ on Iodine scan and thyroid function test showed elevation of thyroid hormones.
· Cosmetic reasons, if the patient asks for it.