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Il nodulo tiroideo

  • alla palpazione:
    • F:5%
    • M:1%
  • all’ecografia: 19-68%
    • maligni: 7-15%

Indicazioni all’esame ecografico:

  1. Evaluation of the location and characteristics of palpable neck masses, including an enlarged thyroid;
  2. Evaluation of abnormalities detected by other imaging examinations, eg, a thyroid nodule detected on computed tomography, positron emission tomography–computed tomography, or magnetic resonance imaging, or seen on another ultrasound examination of the neck (eg, carotid ultrasound);
  3. Evaluation of laboratory abnormalities;
  4. Evaluation of the presence, size, and location of the thyroid gland;
  5. Evaluation of patients at high risk for occult thyroid malignancy;
  6. Follow-up imaging of previously detected thyroid nodules, when indicated;
  7. Evaluation for regional nodal metastases in patients with proven or suspected thyroid carcinoma before thyroidectomy;
  8. Evaluation for recurrent disease or regional nodal metastases after total or partial thyroidectomy for thyroid carcinoma;
  9. Evaluation of the thyroid gland for suspicious nodules before neck surgery for nonthyroid disease;
  10. Evaluation of the thyroid gland for suspicious nodules before radioiodine ablation of the gland;
  11. Identificationandlocalizationofparathyroidabnormalitiesinpatientswithknownor suspected hyperparathyroidism3,4;
  12. Assessment of the number and size of enlarged parathyroid glands in patients who have undergone previous parathyroid surgery or ablative therapy with recurrent symptoms of hyperparathyroidism;
  13. Localization of thyroid/parathyroid abnormalities or adjacent cervical lymph nodes for biopsy, ablation, or other interventional procedures;
  14. Localization of autologous parathyroid gland
AIUM Practice Parameter for the Performance of a Thyroid and Parathyroid Ultrasound Examination

Indicazioni all’esame ecografico:

  • Nodulo palpabile o gozzo multinodulare
  • Noduli tiroidei rilevati con altre metodiche (18FDG-PET , CT, MR)
  • Pazienti ad alto rischio (irradiazione durante l’infanzia, storia familiare, MEN tipo II)
  • Follow up di noduli già noti
  • Linfoadenopatia sospetta
  • Ricerca di recidiva locoregionale dopo tiroidectomia

Non indicato:

  • Screening nella popolazione generale

Composizione



Ecogenicità



Forma



Margini



Calcificazioni



Vascolarizzazione



Dimensioni

  • “The cumulative risk of distant metastasis was the same for PTC and FTC tumors of equal size and increased once the primary tumor size was 20 ”
Machens A, Holzhausen HJ, Dralle H.
The prognostic value of primary tumor size in papillary and follicular thyroid carcinoma. Cancer 2005.
Ito Y, Miyauchi A, Inoue H, et al.
An observational trial for papillary thyroid microcarcinoma in Japanese patients.
World J Surg 2010
Ito Y, Miyauchi A, Kihara M, Higashiyama T, Ko- bayashi K, Miya A 2014
Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation.
Thyroid

Sonographic Patterns

2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and
Differentiated Thyroid Cancer
Bryan R. Haugen, Erik K. Alexander, Keith C. Bible, Gerard M. Doherty, Susan J. Mandel, Yuri E. Nikiforov, Furio Pacini,
Gregory W. Randolph, Anna M. Sawka, Martin Schlumberger, Kathryn G. Schuff, Steven I. Sherman, Julie Ann Sosa,
David L. Steward, R. Michael Tuttle, and Leonard Wartofsky.

ACR Thyroid Imaging, Reporting and Data System (TI-RADS)


ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee
Franklin N. Tessler, MD, William D. Middleton, Edward G. Grant, Jenny K. Hoang, Lincoln L. Berland, Sharlene
A. Teefey, John J. Cronan, Michael D. Beland, Terry S. Desser, Mary C. Frates, Lynwood W. Hammers, Ulrike M.
Hamper, Jill E. Langer, Carl C. Reading, Leslie M. Scoutt, A. Thomas Stavros.

Follow-up


  • Imaging can stop at 5 years if there is no change in size, as stability over that
    time span reliably indicates that a nodule has a benign behavior.

Noduli multipli

  • Il nodulo solitario ha un maggior rischio di malignità
  • I noduli da sottoporre a FNA sono quelli con caratteristiche ecografiche sospette, non i più grandi
Brito JP, Yarur AJ, Prokop LJ, McIver B, Murad MH, Montori VM 2013
Prevalence of thyroid cancer in multinodular goiter versus single nodule: a systematic review and meta-analysis. Thyroid
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