Thyroid nodule is a potential thyroid cancer and hence prompt assessment of all cases is mandatory. Fine needle aspiration (FNA) is a simple and reliable test in the management of thyroid nodule.
This is a prospective audit of all new patients with thyroid nodules referred to our endocrine unit in the period between November 2000 to March 2002. 64 patients were identified, 57(89%) of which were females. The mean average age was 49. Thyroid function test was normal in 57(89%) patients. The mean average time for a new outpatient appointment was 19 days. FNA was performed in the first visit in 40 patients (63%) and was arranged to be performed under ultrasound guidance in 4 patients (6%). There was no clinical indication for FNA in 20 patients (31%)
81% of FNA yielded sufficient cells for diagnosis of which 71% were benign .17% showed follicular neoplasm of which 12% follicular adenoma and 5% benign multinodular thyroid lobe. 2 cases (4%) were confirmed malignant histologically, one was dedifferentiated follicular carcinoma, the patient had total thyroidectomy and referred for radioactive iodine, interestingly this patient has thyroid eye disease and previous radioactive treatment for overactive thyroid. The other patient found to have high-grade non-Hodgkin's Lymphoma subsequently treated with both radiotherapy and chemotherapy. Verbal consent in performing the FNA was obtained and clearly documented in 12 patients (30%) only. 56% of the FNA results were communicated through clinic visit whereas 44% either through letter or telephone call.
Conclusion: FNA should routinely be performed in the first visit, time should be devoted to explain the procedure to the patient and that it is being performed to rule out cancer. Verbal consent should be obtained and clearly documented in the notes. Communicating the result of the FNA by telephone or letter should be avoided.
03 - 05 Nov 2003
Society for Endocrinology