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Thyroid nodule Plan
Thyroid ultrasound
TSH
Radioactive iodine uptake scan if suppressed TSH
Fine needle aspiration (FNA) if thyroid nodule >1-2 cm, risk factors*, suspicious findings on u/s
Endocrinology referral
ENT referral
Repeat thyroid ultrasound in 6 months if benign appearing nodule <1 cm with negative clinical history
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*Risk factors for thyroid cancer :
Head and neck radiation history (especially radiation exposure in childhood)
Palpable thyroid nodule is malignant in 20-50% of previously irradiated thyroid glands
Age <20 years old or over 70 years old
Male gender
Graves Disease
Hypofunctioning thyroid nodules have a risk of papillary thyroid cancer as high as 33 to 42%
Family history of thyroid cancer
Cancer syndromes
Familial adenomatous polyposis
Multiple endocrine neoplasia (MEN) type 2A or 2B
Rapid thyroid nodule growth
Hoarseness
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