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SOLITARY THYROID NODULES

SOLITARY THYROID NODULES - SOLITARY THYROID NODULES...

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SOLITARY THYROID NODULES Solitary thyroid nodules are present in 4% to 9% of patients by clinical examination, and in 22% of patients by ultrasound in the United States; most are benign. 13 Therefore, rather than operating on every patient with a thyroid nodule, the physician or surgeon should select patients for surgery who are at high risk for thyroid cancer. Furthermore, each surgeon must know the complications of thyroidectomy and either be able to perform a proper operation for thyroid cancer in a safe and effective manner or refer the patient to a center where it can be done. LOW-DOSE EXTERNAL IRRADIATION OF THE HEAD AND NECK A history of low-dose external irradiation of the head or neck is probably the most important historical fact that can be obtained in a patient with a thyroid nodule because it indicates that cancer of the thyroid is more likely (in up to 35% of cases), even if the gland is multinodular. 14,15 Low-dose irradiation and its implications are discussed elsewhere. 15a Fortunately, treatments of low-dose radiation for thymic enlargement, tonsils, and acne have long been discontinued. However, patients who had this therapy in childhood are still seen and are still at greater risk of cancer. HIGH-DOSE EXTERNAL IRRADIATION THERAPY High-dose external irradiation therapy, that is, more than 2000 rad, does not confer safety from thyroid carcinoma, as was previously thought. 16 Rather, an increased prevalence of thyroid carcinoma, usually papillary cancer, has been found, particularly in patients with Hodgkin’s
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