Patient with tyroid nodules in the family medicine

Marijana Jandrić-Kočić
Marijana Jandrić-Kočić

Published: 01.12.2018.

Volume 48, Issue 3 (2019)

pp. 29-32;

https://doi.org/10.5937/pramed1904029j

Abstract

Introduction: Thyroid nodules are defined as limited changes in the thyroid structure. A smaller number of thyroid nodules are palpable, only 10% in women and 2% in males. The prevalence of non-imperfect nodules visualized by ultrasound exploration of the structure of the neck (thyroid incidents) is 50%. Not malignant nodes can be found in people with thyroid hyperplasia, inflammatory and autoimmune thyroid diseases, granulomas, hemorrhagic or colloid cysts. Follicular carcinomas include follicular (papillary, follicular, anaplastic and insular carcinoma) and parafollicular carcinoma (medullary carcinoma). Case report:Apatient born in 1965 appears in a family medicine clinic for heart palpitations, malaise, and mood swings. Due to right-sided vetriculomegaly, diffuse reductive changes of the brain parenchyma, sensorimotor neuropathy of the right median nerve, sensory neuropathy of the right ulnaris and radial nerve, depression and arterial hypertension, it is under the supervision of a neurologist, physiatrist, psychiatrist and cardiologist. Physical examination reveals an enlarged, squamous thyroid gland, an ultrasonographically heterogeneous calcified malignantly suspected nodule in the lower poleleft lobe, 18x15 mm in size. The patient is referred to the Department of Nuclear Medicine where an FNAB is done indicating the presence of malignant cells. At the decision of the Oncology Consulium, a total thyroidectomy is performed at the Thoracic Surgery Clinic, followed by radioiodine therapy (131-I). The histopathological findings are: carcinoma papillare lobblateralis sinistri glandulae thyreoideae gradus II-classic type, T1N0. After 24 months, the patient without signs of relapse of malignancy. Conclusion: Educating family medicine physicians in the field of thyroid ultrasound diagnostics and incorporating it into everyday practice would allow significant advances in the diagnostic evaluation of thyroid nodules at the primary care level.

Keywords

References

1.
Republička stručna komisija za izradu i imlementaciju vodiča dobre kliničke prakse, Nacionalni vodič dobre kliničke prakse za dijagnostifikovanje i liječenje tiroidnih nodusa i za diferencirani tiroidni karcinom. In 2012.
2.
Russ G, Leboulleux S, Leenhardt L, Hegedüs L. Thyroid incidentalomas: epidemiology, risk stratification with ultrasound and workup. 2014;3(3):154–63.
3.
Paschke R, Lincke T, Müller SP, Kreissl MC, Dralle H, Fassnacht M. The Treatment of Well-Differentiated Thyroid Carcinoma. 2015;112(26):452–8.
4.
Uppal A, White MG, Nagar S, Aschebrook-Kilfoy B, Chang PJ, Angelos P, et al. Benign and Malignant Thyroid Incidentalomas Are Rare in Routine Clinical Practice: A Review of 97,908 Imaging Studies. Cancer Epidemiology, Biomarkers & Prevention. 2015;24(9):1327–31.
5.
Brown RL, de Souza JA, Cohen EE. Thyroid Cancer: Burden of Illness and Management of Disease. Journal of Cancer. 2011;2:193–9.
6.
Popoveniuc G, Jonklaas J. Thyroid Nodules. Medical Clinics of North America. 2012;96(2):329–49.
7.
Tatlipinar A, Kartal I. The Evaluation of Thyroid Nodules. 2015;4:181.
8.
Ulusoy B. The Management of Thyroid Nodules. 2015;53(4):173–82.
9.
Iftikhar R, Alamri AliF, Khan I, Baig MirzaIA. Trends in ultrasound examination in family practice. Journal of Family and Community Medicine. 2014;21(2):107.

Citation

Copyright

Article metrics

Google scholar: See link

The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Most read articles

Indexed by