INCIDENTAL
THYROID NODULES (ITNS) -clinical importance and the responsibility of the
clinician
ITNs are
defined as discrete nonpalpable lesions of the thyroid radiologically distinct
from the surrounding parenchyma, found on anatomic imaging studies performed
for indications other than planned assessment of the thyroid gland. The rate of
identification and the subsequent rate of malignancy of ITNs depends on the initial
imaging modality. ITNs are found on:
20 – 67 % of
ultrasound examinations
Up to 25 %
of contrast-enhanced thoracic computed tomography (CT) scans
16 – 18 %
of magnetic resonance imaging (MRI) scans
1-2.5 % of
positron emission tomography (PET) scans
With the
wide use of modern medical technology and the increasing societal demand for
imaging, the incidence of ITNs is rising, thereby making the identification of
these patients needing further evaluation, biopsy and surgical intervention
essential. The clinician should be able to recognize features indicating the
presence of underlying malignancy, based on findings from history, clinical
examination, imaging characteristics, and laboratory investigation (for
example, increased calcitonin levels), in order to diagnose a highly curable
cancer (present in about 5 % of all thyroid nodules).
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