The patient's account is presented in Appendix 1. 2.1 Clinical history The patient first presented to the ED with a chief complaint of anterior neck discomfort, neck stiffness, and neck swelling that had developed over the course of the day. [journals.lww.com]

Goiter, which is commonly characterized with swelling and pain, is the most commonly presented condition. [hyperthyroidismsymptomsx.com]

Practice CMAJ September 21, 2010 182 (13) E632; DOI: https://doi.org/10.1503/cmaj.091167 A 72-year-old woman presented with a sudden onset of pain, swelling and bruising of her neck that had occurred two days prior to presentation. [cmaj.ca]

Multiple septae are present in the cystic lesion of the left lobe of thyroid. [ultrasound-images.com]

Internal gas collections may be present. [23] Figure 20: Abscess. [ijri.org]

• Thyroid Nodule

  Post View 25 Comments Thyroid Nodules - Treatment What was the treatment for your thyroid nodules? Post View 1 Comment Thyroid Nodule - Experience Please describe your experience with thyroid nodule. [emedicinehealth.com]

  View/Print Figure Fine-Needle Aspiration of Thyroid Nodule FIGURE 5. Algorithm for fine-needle aspiration of a thyroid nodule. Fine-Needle Aspiration of Thyroid Nodule FIGURE 5. Algorithm for fine-needle aspiration of a thyroid nodule. [aafp.org]

  F ig 1. 16-year-old boy with a purely cystic thyroid nodule (group A). A, Ultrasonogram obtained before ethanol sclerotherapy shows a huge hemorrhagic thyroid nodule. [ajnr.org]

  This article reviews the current techniques for sonographic evaluation of the thyroid and the imaging features of the various types of thyroid nodules. Thyroid nodules are a ubiquitous clinical problem. [radiologykey.com]

• Goiter

  This is called a toxic nodular goiter. Colloid nodular goiters are also known as endemic goiters and are usually caused by inadequate iodine in diet. [uclahealth.org]

  A goiter is known as a nodular goiter when it is caused by thyroid nodules and a diffuse goiter when nodules are not present. Risk Factors Women are more prone to thyroid disorders than men and, therefore, more likely to develop a goiter. [verywell.com]

  Multinodular Goiter A multi-nodular goiter is an enlarged thyroid gland with a goiter comprised of multiple thyroid nodules. [endocrine.surgery.ucsf.edu]

  Endemic goiter is defined as thyroid enlargement in more than 10% of the population while sporadic goiter is a result of factors that do not affect the general population. Nontoxic goiter is more common in women than men. 3.1. [ocw.tufts.edu]

  The thyroid goiter has frequent sites of hemorrhage as the cause of these large cysts. These cysts occur in thyroid glands that are already abnormal with goiter formation. The cyst is never all alone in a normal thyroid gland. [thyroidnosurgery.com]

• Malaise

  Hashimoto's thyroiditis Multinodular goiter Thyroid cyst or Thyroid adenoma Thyroiditis nodule Subacute thyroiditis Firm or hard, tender thyroid; may be unilateral Usually seen in association with thyroidal tenderness, systemic symptoms of fever and malaise [enotes.tripod.com]

  Inflammatory thyroid disease be it acute inflammatory condition, like DeQuervain thyroiditis, or more chronic variety like Hashimoto’s autoimmune thyroiditis will reveal fever, pain, malaise and local tenderness. [waent.org]

  Hyperthyroidism Autoimmune thyroiditis (Hashimoto, chronic lymphocytic) Persistent immune system inflammation of person's own thyroid Goiter Hypothyroidism Subacute thyroiditis (painful, de Quervain) Viral infection Painful, tender and swollen gland Malaise [endocrine.surgery.ucsf.edu]

• Thyroid Tenderness

  […] or Thyroid adenoma Thyroiditis nodule Subacute thyroiditis Firm or hard, tender thyroid; may be unilateral Usually seen in association with thyroidal tenderness, systemic symptoms of fever and malaise; characterized by elevated sedimentation rate and [enotes.tripod.com]

• Short Stature

  Other consequences of severe iodine deficiency include hypothyroidism and cretinism, a syndrome of mental retardation, short stature, deafness, and characteristic facial deformities that affects children born to hypothyroid mothers in iodine deficient [endocrine.surgery.ucsf.edu]

• Acne Vulgaris

  vulgaris, or current indications such as Hodgkin's lymphoma. [en.wikipedia.org]

• Tremor

  Calling your health care provider: Call your health care provider if signs of thyrotoxicosis develop: Fever Increased pulse rate Palpitations Diarrhea or constipation Nausea Fatigue Dry Skin Sweating Tremors Anxiety Shortness of breath Prevention: Use [uclahealth.org]

  Symptoms of hyperthyroidism include: Irritability/nervousness Muscle weakness/tremors Light or missed menstrual periods Weight loss Difficulty sleeping Enlarged thyroid gland Vision problems or eye irritation Heat sensitivity (trouble dealing with heat [my.clevelandclinic.org]

  Symptoms can include: unintended weight loss nervousness and tremor fast or irregular heartbeat intolerance to heat Hashimoto's thyroiditis Hashimoto's thyroiditis is an autoimmune condition in which the body's immune system attacks the thyroid gland. [medicalnewstoday.com]

  Weight loss, sweating, tremors, anxiety state, sleeplessness and wet palms would point to a hyperactive state. Weight gain, apathy, sleepiness would point to a hypothyroid state. [waent.org]

• Apathy

  Weight gain, apathy, sleepiness would point to a hypothyroid state. [waent.org]

Otherwise incidental finding of thyroid nodules found on the inpatient service can be deferred to outpatient workup and management. [clinicaladvisor.com]

American College of Radiology recommends the following workup for thyroid nodules as incidental imaging findings on CT, MRI or PET-CT : [8] Features Workup High PET signal or Local invasiveness or Suspicious lymph nodes Very likely ultrasonography Multiple [en.wikipedia.org]

Thyroid Scanning The use of radioisotope scanning has nearly been abandonded in the initial workup of a thyroid nodule. This test is performed by a nuclear medicine specialist. [emedicinehealth.com]

Applying the society of radiologists in ultrasound recommendations for fine-needle aspiration of thyroid nodules: Effect on workup and malignancy detection. AJR Am J Roentgenol 2014;202:602-7. [ PUBMED ] 3. [sjmms.net]

[…] utmost necessary to achieve a favorable treatment outcome. [hyperthyroidismsymptomsx.com]

Radioactive iodine treatment (RAI): With this treatment, you are given a dose of radioactive iodine, which shrinks the thyroid gland. [verywell.com]

Treatment of cystic lesions of the thyroid by ethanol instillation. World J Surg 1992 ; 16 : 958 –961 Verde G, Papini E, Pacella C, et al. Ultrasound guided percutaneous ethanol injection in the treatment of cystic thyroid nodules. [ajnr.org]

treatment to conceive, and in very sick patients who need immediate intervention. [nyhni.org]

If the goiter is producing too much thyroid hormone, treatment with radioactive iodine, antithyroid medication, or surgery may be necessary. Expectations (prognosis): The prognosis is good with treatment. [uclahealth.org]

Expectations (prognosis): The prognosis is good with treatment. A persistent goiter may become toxic, causing symptoms of excess thyroid hormones to develop. [uclahealth.org]

A clinical study on incidence, prognosis and operative treatment with the Bristow–Latar-jet procedure [dissertation]. Linköping: Linköpings universitet; 1982. Thesis 2. Cunningham N. [ortobas.se]

Morphology and prognosis. Virchows Arch A Pathol Anat Histol. 1982, 396(1):19-39. 6. Rosai J, Cargangiu ML, Delellis LA. Tumors of the thyroid gland. In: Rosai J, Cargangiu ML, Delellis LA. Atlas of tumor pathology. [arquivosdeorl.org.br]

The prognosis for the patient depends largely on the cell type and how far the cancer has spread at the time of diagnosis. [medicinenet.com]

Pathophysiology The histopathology varies with the etiology and duration of the goiter. [ocw.tufts.edu]

Etiology Benign thyroid nodules ( ∼ 95% of cases) Thyroid Adenomas Adenomas are benign epithelial tumors derived from glandular epithelium. [amboss.com]

Hemorrhagic Cysts of the Thyroid Gland 1896 Hemorrhagic Cysts of the Thyroid Gland 1896 W.I.Bradley McGill University Comment: The etiology of cysts was looked at in the this paper from 1896. [thyroidnosurgery.com]

The case presentation is followed by a literature review where known etiologies of thyroid hematoma including traumatic and nontraumatic causes, precipitating anticoagulation, and spontaneous rupture of branches of the external carotid artery are outlined [journals.lww.com]

Benign Etiologies of Thyroid Nodules: Adenomas (macrofollicular, microfollicular) Colloid nodules Congenital abnormalities Simple or hemorrhagic cysts Lymphocytic or granulomatous nodules Hyperplastic nodules Subacute and Hashimoto’s thyroiditis Malignant [clinicaladvisor.com]

Epidemiology References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. Etiology Benign thyroid nodules ( ∼ 95% of cases) Thyroid Adenomas Adenomas are benign epithelial tumors derived from glandular epithelium. [amboss.com]

Epidemiology Palpable thyroid nodules in the pediatric and adolescent population are relatively rare, having an estimated prevalence of 0.2% to 1.4%, which is 5 to 10 times less than in adults. ( 1 ) Despite their lower occurrence, studies estimate 9% [pedsinreview.aappublications.org]

Epidemiology [ 1, 4 ] Between 4-7% of adults have palpable thyroid lumps. Many more will be detectable on high-definition ultrasonography. [patient.info]

"Thyroid incidentalomas: epidemiology, risk stratification with ultrasound and workup". European Thyroid Journal. 3 (3): 154–63. doi : 10.1159/000365289. PMC 4224250. PMID 25538897. ^ Jenny Hoang (2013-11-05). [en.wikipedia.org]

Pathophysiology The histopathology varies with the etiology and duration of the goiter. [ocw.tufts.edu]

[…] either FNA (based on sonographic criteria) or monitoring (with repeat ultrasounds) if criteria are not met Sonographic criteria for fine-needle aspiration ( FNA ) References: [1] [3] Follicular adenoma Toxic adenoma Toxic multinodular goiter Epidemiology Pathophysiology [amboss.com]

The routine use of iodized table salt now helps prevent this deficiency. Risk factors are being female, being older than 40, having an inadequate dietary intake of iodine, living in an endemic area, and having a family history of goiters. [uclahealth.org]

This happens when the small blood vessels in the nodule tear and bleed - it is common and not known to be preventable (of course, blood thinners may increase this risk). The body will absorb the blood, no specific treatment is needed. [medhelp.org]

This type of treatment usually prevents recurrence of the cyst. You do not need to be hospitalized, and this type of procedure is carried out even without anesthesia. [quest4health.com]

Understanding these US and pathologic features could prevent repeated fine-needle aspiration or unnecessary diagnostic surgery. [e-ultrasonography.org]

It is important to avoid direct sun exposure for the first year to prevent darkening of the scar. [nyhni.org]