5. OBJECTIVES AND EVALUATION OF THYROID NODULES To exclude malignancy Regarding adequate and ideal treatment of STN METHODS TO ACHIEVE THE OBJECTIVES Clinical evaluation Investigations : FNAC Test of thyroid function Thyroid scintiscan Thyroid USG Fluorescant scanning MRI/CT – very rarely

10. 30% 9% 4% 5% Hot 13% 19% 9% 9% Warm 22% 72% 16% 84% Cold Malignant % Malignant % uptake Tc 99 I 123

11. FNAC is inconclusive and scan shows warm or hot nodules Warm nodules – A trial of TSH suppression using thyroxin may cause regression of nodule Autonomously functioning hot nodule – I131 ablation therapy may serve as a useful alternative to surgery.

13. CXR : In presence of obstructive symptoms tracheal deviation or suspected retrosternal extension. Cacification within papillary carcinoma of thyroid as psammona bodies. MRI/CT : STN are being found incidently during MRI/CT for reason not relating to thyroid gland. Fluorescent scanning: Determines intra – thyroid iodine content is an unproven technique for defferentiating bening from malignant thyroid nodule currently remains a research tool.

16. If benign and lesion is solid : thyroid scintiscan Low Risk Warm: TSH suppression trial by thyroixin, if response positive ; continue for 6 months or till nodules disappeared Cold : hemithyroidectomy Hot nodules : I131 ablation or hemithyroidectomy High risk – even if FNAC is negative for malignancy hemithyroidectomy is advocated Hemithyrodectomy is useful if FNAC is inconclusive or reported as follicular neoplasm.

19. CONCLUSION: With the advent of current diagnostic technique and with their appropriate use in diagnosis of STN, it is now possible to have a selective approach to management of STN by identifying the patient likely to have malignancy and avoiding thyroidectomy in majority of patient with benign diseases who can be given conservative medical treatment.

20. THANK YOU