9. Four different 99mTc scan patterns. ( A ) Normal thyroid, showing function in both lobes connected by the isthmus. ( B ) A 38-year-old man with hyperthyroid Graves’ disease, thyroid-stimulating hormone (TSH) of 0.006 mIU/L, and radioiodine uptake of 92%. Note that the scan shows enlarged thyroid gland with intense and diffuse uptake.( C ) A 38-year-old woman with a palpable, 2-cm cold nodule in the right thyroid lobe. The nodule was benign on biopsy. ( D ) A 39-year-old man with a palpable 3-cm right thyroid nodule, hyperfunctioning on scan, with completely suppressed uptake in the rest of the gland. Serum level of TSH was 0.05 mIU/L and radioiodine uptake was 22%.
12. Thyroid cytology. ( A ) Nondiagnostic smear. Degenerative foam cells without follicular cells (PAP; Ч60). ( B ) Colloid nodule. Cohesive group of thyroid cells in a patient with multinodular goiter (PAP; Ч50). ( C ) Hashimoto thyroiditis. Lymphocytes and H¨urthle cells showing abundant granular cytoplasm (PAP; Ч250). ( D ). Follicular neoplasm. Hypercellular aspirate with microfollicular pattern lacking colloid is indeterminate (PAP; Ч205). Nodule was a benign follicular adenoma at surgery ( E ) Papillary carcinoma. Cellular specimen showing tumor cells with irregular, enlarged nuclei. Note lack of colloid(PAP; Ч100). ( F ) Medullary carcinoma. Loosely cohesive neoplastic cells with elongated nuclei. (MGG stain; Ч400). Abbreviations : MGG, May–Grunwald–Giemsa stain; PAP,Papanicolaou stain.
13.
14. Reduction of nodule volume of at least 50% (random effects model). The right side indicates improvement in reduction. The size of the filled diamond at the middle of the central line ( arrow 1) represents the sample size of each study. The box ( arrow 2)represents the 95% confidence interval (CI) of the relative risk (RR; marked with a line inhe box). The unfilled diamond with a central line ( arrow 3) denotes the pooled risk ratio itself. Abbreviation : T4, levothyroxine. Source : From Ref. 96.
15. Management of patient with a multinodular goiter (MNG). Evaluation begins by determining thyroid-stimulating hormone (TSH) levels; suppressed TSH (0.1 mIU/L) suggests subclinical or clinical hyperthyroidism and the patient is treated accordingly. Most often, when TSH is normal (nontoxic goiter), fine-needle aspiration (FNA) biopsy results decide management. Benign and/or small goiters are followed without thyroxine therapy. Symptomatic, large MNGs are treated with either surgery or radioiodine (131I). Malignant goiters are surgically excised. Abbreviations : FT4, free thyroxine; N, normal;RAIU, radioiodine uptake; Rx, therapy; T3, triiodothyronine; US, ultrasound.
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