Evaluation of Nodules · Consultation and Follow-up · Other Sites · References
Q: " …I am a 32 year old thyroid cancer survivor (diagnosed in Dec'99). I am doing well - it seems - however, lately, I do not feel well. My hands and neck hurt and I have a sore throat. I'm not sure but I may have swollen glands. My thyroglobulin levels are less than 1 so I know that is good - but I don't feel quite right and these pains are bothering me. Any suggestions...."
Thyroid nodules are common and although only a small percentage are malignant, you must maintain a high index of suspicion for malignancy. In all cases, immediate consultation or referral is imperative.
Evaluation of Nodules
Signs of Thyrotoxicosis?
The Role of Thyroglobulin(TG)
In cases of patients with hyperparathyroidism, more than two-thirds show no symptoms; laboratory analysis will reveal elevated serum calcium levels (hypercalcemia).
Again, immediate consultation or referral is a must, so all patients with differentiated thyroid carcinoma are followed clinically for: neck palpation(examination), physical examination, chest x-rays and observation for thyrotoxicosis that might indicate functioning metastases.
About 6-12 months after their postoperative scan, patients usually receive another 131I(radioactive iodine) whole body scan and serum thyroglobulin measurement while hypothyroid; these procedures have a combined sensitivity of 95% for metastases. Serum thyroglobulin in a patient receiving thyroxine has a lower sensitivity of 62%.
Thyroid Cancer Survivors' Association
Johns Hopkins Thyroid Tumor Center
Gray Cancer Institute
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