Thyroid nodule
Case report:
A 78-year-old patient with an incidental finding of a hypodense thyroid lesion on cardiac CT performed prior to planned aortic valve surgery. Ultrasound examination revealed a thyroid gland of normal size with a 2-cm hypoechoic nodule (EU-TIRADS 4); color Doppler imaging showed no significant intranodular blood flow. Elastometry showed increased tissue stiffness. The TSH level was within the normal range, and there were no clinical indications of thyroid disease. An ultrasound-guided core needle biopsy and a fine-needle aspiration with cytological analysis (cytospin) were performed. Histologically, a follicular nodule was identified. Pathologist’s comment: Based on the biopsy, a follicular neoplasm cannot be reliably distinguished from an autonomous adenoma. Thyroid scintigraphy should be performed for functional evaluation (to detect an autonomous adenoma). Due to the prior administration of contrast medium (cardiac CT), a thyroid scintigraphy is only possible after ≥8 weeks. At present, treatment of the severe aortic stenosis is prioritized. If scintigraphy shows no evidence of autonomy, surgical evaluation via diagnostic hemithyroidectomy should be considered due to the risk of a follicular neoplasm. Alternatively, ultrasound follow-up at 6 and 12 months may be performed.
