Regardless of how a thyroid nodule is detected, an ultrasound scan of the thyroid gland is the ideal scan to characterise thyroid nodules. The appearance of each thyroid nodule in the ultrasound scan will guide us as to how likely a nodule is to be benign or cancerous. However, it is still not possible to differentiate between benign or cancerous thyroid nodules just by using an ultrasound scan alone. A fine needle aspiration and biopsy (FNAB) may be recommended if the nodule has ultrasound features suspicious of cancer.
Fine needle aspiration biopsy (FNAB) is a minor procedure performed in the clinic or as a day surgery procedure, where a fine needle is inserted into the nodule under ultrasound guidance to obtain cells for further analysis in the laboratory to determine if the nodule is cancerous or non-cancerous.
Thyroid function tests assess the levels of your thyroid hormones (T4) and thyroid-stimulating hormone (TSH). These tests evaluate the health of your thyroid gland before any further tests are done.
If you have hyperthyroidism and your levels of thyroid hormones are too high, you may experience symptoms such as palpitations, feeling hot easily, irritability, diarrhoea, weight loss, and increased appetite.
On the other hand, if you have hypothyroidism, meaning your thyroid gland is underactive, you may feel tired and lethargic, gain weight easily, experience constipation, have memory loss, and feel cold easily.
In addition to FNAB and thyroid function tests, other diagnostic tests may be performed to further evaluate thyroid nodules, such as a thyroid uptake scan.
Thyroid uptake scan
The purpose of this scan is to determine if the thyroid nodule is producing too much thyroid hormones in a patient who has thyroid nodules and hyperthyroidism. It involves an injection of a small amount of radioisotope (known as tracer) to distinguish between functioning and nonfunctioning nodules.
A nodule that takes up more of the tracer than normal thyroid tissue is known as a “hot” nodule, whereas a nodule that takes up less tracer than normal thyroid tissue is known as a “cold nodule”. “Hot” nodules are rarely cancerous. It is not possible to differentiate between a “cold” nodule which is cancerous and one that is not cancerous. This will depend on the presence of suspicious imaging features of thyroid ultrasound which is usually performed together with the thyroid uptake scan and potential further evaluation by FNAB.
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