In order to better manage patients with thyroid disorders, the Haute Autorité de Santé (HAS) and the National Professional Council for Radiology and Medical Imaging (G4) have collaborated to publish new recommendations. In which cases should the ultrasound be preferred? For whom is a fine needle aspiration necessary?
“Ultrasound of the thyroid should not be systematic”
There are two main forms of thyroid pathology. They can come from a dysfunction, called dysthyroidism, or from a structural abnormality in the gland that can lead to the appearance of goiter or nodules. These disorders are quite frequent in the population and medical care today raises questions, in particular concerning the relevance and quality of the care to be provided. Experts cite as an example, the ” almost systematic recourse […] on ultrasound in case of hyperthyroidism », Which is not always justified.
Dysthyroidism is characterized by:
- hypothyroidism: the thyroid secretes too many hormones;
- hypothyroidism: the gland does not produce enough hormones.
In the case of the discovery of dysthyroidism, imaging does not always have to be systematic. Indeed, the HAS specifies today that for hypothyroidism, “ Ultrasound is generally not indicated except in a few situations (palpable nodule or lymphadenopathy; presence of signs of compression which make it difficult to swallow, breathe or speak. »It must be offered on a case-by-case basis by the healthcare professional, in particular in the event of difficult palpation or if the patient has a risk factor for cancer of this gland. On the other hand, concerning ” hyperthyroidism, imaging is not useful in Graves’ disease “. This condition is an autoimmune disease of the gland, the clinical signs of which are very characteristic, such as swelling of the thyroid or exophthalmos.
Mandatory fine needle aspiration before any surgical operation
Another problem has been observed among professionals: the absence of fine needle aspiration before removal of the nodules. Indeed, ” two out of three thyroid ablations are performed without prior fine-needle aspiration, which leads to the practice of thyroidectomies for benign nodules which for the most part do not require [90 % des cas] than a simple surveillance. “However, irrelevant thyroidectomies” lead to unnecessary risks associated with surgery and lifelong hormone therapy. ”
As the Health Authority reminds us, nodules are quite common. These are lumps located in the neck in the gland. However, it is imperative to detect the risk of nodule malignancy by means of a TSH (thyroid stimulating hormone) test and ultrasound. Once these two examinations have been carried out and only if risk nodules have been identified, a fine needle aspiration should be performed. The goal is to collect any suspicious cells using a very fine needle inserted into the area of the nodule. Next, ” the subsequent action to be taken (further fine needle aspiration, clinical and ultrasound monitoring or thyroid surgery) will depend on the ultrasound characteristics and the results of the fine needle aspiration. “