Benign Thyroid ABSITE and Board Review

ABSITE and board review for benign thyroid problems and anatomy. Content includes:
Thyroid anatomy
Hypothyroid causes
Hyperthyroid causes
Thyroid nodule evaluation
One of our very kind ENT surgeons reviewed this and had some suggestions:
11:59: Not all TGDCs require surgical excision if they are incidentally found & have not been a source of recurrent infection. Thyroid cancer arising in them is pretty rare, so generally FNA is not indicated, but if there is any concern (i.e. rapid growth, risk factors for thyroid cancer like radiation exposure, or unusual presentation) then I get one pre-op. Also important to confirm they have a normal thyroid lower in their neck pre-op to avoid post-op hypothyroidism (though this is also pretty rare).
13:15: TI-RADS criteria is now a standard for thyroid US that uses some of the things you mentioned to assess risk of nodules being malignant & the FNA recommendations are based off of this. In the past we used to FNA any hypoechoic nodule greater than1 cm.
TI-RADS 1: Benign, less than 2% malignancy risk: No FNA
TI-RADS 2: Not suspicious, less than 2% malignancy risk: No FNA
TI-RADS 3: Mildly suspicious, 5% malignancy risk: FNA if greater than 2.5 cm
TI-RADS 4: Moderately suspicious, 5-20% malignancy risk: FNA if greater than 1.5 cm
TI-RADS 5: Highly suspicious, greater than 20% malignancy risk: FNA if greater than 1.0 cm
13:58: Most repeat US recommendations are now for 12 mos.
14:30: Bloody cyst contents are not necessary a hard indication for lobectomy
14:38: AUS & FLUS (Bethesda 3 & 4) FNAs are now good candidates for Afirma molecular testing that tests for specific mutations & then gives a risk percentage of the nodule being malignant. Lobectomy is still considered & offered to some patients, so it depends on their personal preference but we do use Afirma often in this setting.
Not sure if this is best included in this or the other video, but a caveat is made for thyroid nodules greater than 4 cm even in the lack of compressive symptoms. If someone has a thyroid nodule greater than 4 cm, the recommendation is generally lobectomy regardless of FNA results because the risk of sampling error in such a large nodule is considered high enough to be clinically relevant.

[@venturasurgeryschool796]

One of our very kind ENT surgeons reviewed this and had some suggestions:
11:59: Not all TGDCs require surgical excision if they are incidentally found & have not been a source of recurrent infection. Thyroid cancer arising in them is pretty rare, so generally FNA is not indicated, but if there is any concern (i.e. rapid growth, risk factors for thyroid cancer like radiation exposure, or unusual presentation) then I get one pre-op. Also important to confirm they have a normal thyroid lower in their neck pre-op to avoid post-op hypothyroidism (though this is also pretty rare).
13:15: TI-RADS criteria is now a standard for thyroid US that uses some of the things you mentioned to assess risk of nodules being malignant & the FNA recommendations are based off of this. In the past we used to FNA any hypoechoic nodule greater than1 cm.
TI-RADS 1: Benign, less than 2% malignancy risk: No FNA
TI-RADS 2: Not suspicious, less than 2% malignancy risk: No FNA
TI-RADS 3: Mildly suspicious, 5% malignancy risk: FNA if greater than 2.5 cm
TI-RADS 4: Moderately suspicious, 5-20% malignancy risk: FNA if greater than 1.5 cm
TI-RADS 5: Highly suspicious, greater than 20% malignancy risk: FNA if greater than 1.0 cm
13:58: Most repeat US recommendations are now for 12 mos.
14:30: Bloody cyst contents are not necessary a hard indication for lobectomy
14:38: AUS & FLUS (Bethesda 3 & 4) FNAs are now good candidates for Afirma molecular testing that tests for specific mutations & then gives a risk percentage of the nodule being malignant. Lobectomy is still considered & offered to some patients, so it depends on their personal preference but we do use Afirma often in this setting.
Not sure if this is best included in this or the other video, but a caveat is made for thyroid nodules greater than 4 cm even in the lack of compressive symptoms. If someone has a thyroid nodule greater than 4 cm, the recommendation is generally lobectomy regardless of FNA results because the risk of sampling error in such a large nodule is considered high enough to be clinically relevant.

[@vaishnavi118]

Thanks for sharing

[@jhoshm]

thank you so much sir, your vedios are a gem specially your GI series is phenomenal. was eagerly waiting for your new vedios. would be really grateful if u spoke a bit about speen, skin and urology .

[@ahmedalshabani6234]

Great explaining we want urology and a lot mnemonic in general surgery