Adenoma Thyroid

Fanny Indarto

Goiter
Goiter : thyroid enlargement
refers to enlargement resulting from
a variety of benign conditions:
physiological (puberty,pregnancy),
metabolic (dietary iodine deficiency, i.e.,
endemic goiter),
abnormal iodine metabolism, or
inflammatory/ autoimmune diseases
(Hashimotos disease,Graves disease).
Endocrine Surgery,2004

Thyroid Nodule

Sabiston,2017

Schwartz's Principles of Surgery,

2010

Adenoma
Prolonged thyroid enlargement
results in the formation of multiple
adenomatous nodules, which may
undergo hemorrhageand fibrosis,
leading to a multinodular
(adenomatous) goiter.

Adenoma Types

Folicular Adenoma
Hu rthle Cell Adenoma
Atypical Adenoma?
Hyalinizing Trabecular Tumor

Folicular Adenoma
The most common solitary thyroid mass is
an adenoma.
These are encapsulated, benign, expansions
of thyroid follicles, compressing adjacent
thyroid parenchyma.
On gross inspection, the capsule is usually
thin and flimsy; a thickened capsule can
raise the diagnostic possibility of a
minimally invasive follicular carcinoma

 Once a thyroid nodule is detected by

physical examination, a TSH level is
obtained and UG-FNA performed.
If the TSH is depressed, radioiodine
scanning and uptake is undertaken to
determine whether there are one or
more nodules with autonomous
function or one or more nonfunctioning
nodules with internodular thyroiditi

 Surgery is also appropriate for patients when the

thyroid nodule is:
(1) symptomatic (dyspnea, dysphagia,or venous
compression), enlarging, or at risk of becoming
symptomatic,
(2) autonomous,and radioactive iodine therapy is
refused
(3) cosmetically a problem
(4) suspicious or diagnostic for a malignancy
(5) none or the above,but the patient cannot tolerate
the uncertainty of whether the nodule could
represent a malignancy,

 If the TSH is normal or elevated,

radioiodine scanning is not necessary.
Thyroid hormone replacement therapy is
started if the patient is hypothyroid.
Observation is indicated for asymptomatic,
nonfunctioning thyroid nodules with benign
cytology or if the cytology is
indeterminate/nondiagnostic and the
patient is at low risk for thyroid cancer.

Toxic multinodular goiters

usually occur in older individuals, who often have a
prior history of a nontoxic multinodular goiter.
Over several years, enough thyroid nodules become
autonomous to cause hyperthyroidism
Hyperthyroidism also can be precipitated by iodidecontaining drugs such as contrast media and the
antiarrhythmic agent amiodarone
Hyperthyroidism must be adequately
controlled. Surgical resection is the preferred
treatment of patients with toxic multinodular goiter
with subtotal thyroidectomy being the
standard procedure.
Schwartz, 2010

Toxic Adenoma (Plummer's Disease)

Hyperthyroidism from a single hyperfunctioning nodule
typically occurs in younger patients who note recent growth
of a long-standing nodule along with the symptoms of
hyperthyroidism.
Most hyperfunctioning or autonomous thyroid nodules have
attained a size of at least 3 cm before hyperthyroidism
occurs. Physical examination usually reveals a solitary thyroid
nodule without palpable thyroid tissue on the contralateral
side. RAI scanning shows a "hot" nodule with suppression the
rest of the thyroid gland. These nodules are rarely malignant.
Smaller nodules may be managed with antithyroid medications
and RAI. Surgery (lobectomy and isthmusectomy) is
preferred to treat young patients and those with larger
nodules.
Schwartz, 2010

Incidence
Most true intrathyroidal nodules will
represent colloid adenomas (27
60%) or simple follicular
adenomas (2640%).
About 5% of thyroid nodules are
classified as hyperfunctioning and are
hot on radionuclide scanning based
on a relative increased ability to trap
iodide.
Thyroid Cancer, Wartosky, 2006

USG

 Hot or hyperfunctioning nodules

indicate significant increased radioiodine
uptake relative to normal thyroid tissue,
with or without suppression of the
remaining thyroid tissue.
Sometimes warm has also been used to
describe the latter, which again is an area
on the scan that has slightly increased
radioiodine uptake in association with
adjacent normal thyroid tissue.

Pathophysiology of Diseases, 1997