A thorough history and physical exam remains a critical step in thyroid nodule evaluation. Symptoms of thyrotoxicosis or hypothyroidism, local compressive symptoms, voice changes, and/or the presence of dysphagia should be elicited. In addition, patients should be questioned regarding a personal history of head or neck irradiation, or a family history of either thyroid cancer or other familial syndromes, as there are several known to be associated Inhibitors,research,lifescience,medical with an increased risk for thyroid cancer (Table

1).5,6 Table 1. Familial Syndromes Associated With Thyroid Cancer.5,6 On exam, it is important to note both the character and size of the nodule in question, whether the nodule is fixed or mobile, as well as to assess

for the presence of neck tenderness, tracheal deviation, or potentially concerning cervical lymphadenopathy. All patients with dysphonia or prior history of cervical or thoracic operations with concern for recurrent laryngeal nerve injury Inhibitors,research,lifescience,medical should be evaluated with direct laryngoscopy to assess vocal cord function and for preoperative planning. An ultrasound (US) of the neck should be obtained in order to evaluate the nodule in question and the remainder of the gland for synchronous findings. Concerning features Inhibitors,research,lifescience,medical on US include nodules that are hypoechoic, have increased vascularity, contain calcifications, or have irregular shape (classically taller than wide) and borders, or evidence of extra-thyroidal extension or invasion of surrounding structures. The remainder of the neck (bilateral central

and lateral compartments) should be assessed to evaluate for the presence of abnormal lymph nodes.2 Modeled Inhibitors,research,lifescience,medical after the Breast Imaging Reporting and Data System (BIRADS), developed by the American College of Radiology, the Thyroid Imaging Reporting and Data System (TIRADS) was designed in order better to standardize the classification of thyroid lesions and allow for enhanced Inhibitors,research,lifescience,medical communication among treating physicians in co-ordinating clinical management. The selleck screening library TIRADS scale ranges from 1 to 6, a score of 1 representing a normal thyroid gland, a 2 signifying a benign condition with no risk of malignancy, 3 being Oxalosuccinic acid used for nodules that are likely benign, with a corresponding risk of malignancy of less than 5%, 4 denoting a suspicious nodule, with malignancy risk ranging from 5% to 80%, 5 being used to describe a nodule that is likely malignant, with a greater than 80% estimated likelihood, and, similarly to the BIRADS scale, a 6 signifying known malignancy, proven by prior biopsy. In a prospective study of nearly 2,000 lesions, the TIRADS scale was found to have a sensitivity and specificity of 88% and 49%, respectively. In addition, they found a positive predicative value of 49%, negative predictive value of 88%, and accuracy of 94%.