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Thyroid Nodules (Cancers (Papillary (Most common (85%) orphan Annie…

- - - - U/S findings
        
        Solid mass
        
        Hypoechogenic
        
        (difference from thyroid tiss)
        
        Size difference > 2cm
        
        micro calcifications :glass_of_milk:
        
        irregular borders
      - Fixed firm hard nodule
        w/ nearby LAD.
        
        ~~painful~~ nodule unlikely
        
        :pencil2: most malignancies are painless, but don't rely on this finding for cancer.
- - - - Low risk nodule
        
        :pencil2:We do not know if this is endogenous or ectopic production
        
        RAIU scan
        
        :check: Hot
        
        hyper functioning nodule
        
        lowest risk for cancer (no biopsy)
        
        Tx for hyperthyroidism (RAI, ablation)
        
        :green_cross:Cold Nodule
        
        Nonfunctioning
        
        :warning:risk for cancer!
        
        Get FNA : better choice
        
        US is an option
    - - :warning:High risk nodule
        
        US
        
        Big: Nodule > 1cm
        
        FNA
        
        feel this: hard hypoechogenic = biopsy
        
        :pencil2:A scary hx should push you to choose FNA even if its not big
        
        FNA
        
        Cancer?
        
        :check: Yes,
        
        cut it out :hocho:
        
        :green_cross:No cancer
        
        f/u US 6 mo
        
        rebiopsy if it grows
        
        :shrug::skin-tone-2:Inconclusive
        
        immediately repeat FNA #
        
        Small: Nodule < 1cm
        
        Watch and wait
        
        repeat US (6-12 mo) :checkered_flag:
        
        feel this: cystic? let it get to ≥2cm