Thyroid nodules: a puzzle in gynaecological endocrinology

Introduction. We present different particular aspects of the thyroid ultrasound in patients who were first referred to an endocrinologist after a gynaecological check-up. Case series presentation. A 73-year-old woman was admitted for a routine gynaecological and general exam, after a thyroid nodule was incidentally detected. Ultrasonography showed a macronodule of 3.1 cm, that was treated by surgery. A 53-year-old woman presented for hot flashes in association with high blood pressure episodes. Hyperthyroidism was not confirmed, but a conglomerate of thyroid nodules of 2.2 cm was detected. The fine needle aspiration excluded a malignancy. A 66-year old woman, presenting for bone assessment, was incidentally detected with a large multinodular goitre. The left lobe has multiple nodules including TIRADS4 conglomerate. A 43-year-old woman, with bilateral mammary cysts, normal TSH, increased prolactin, presented at thyroid ultrasound a left lobe of 5.4 cm, with a conglomerate of 3.3 cm. The fine needle aspiration showed Hürthle cells and the patient was referred to surgery, which confirmed the diagnosis of follicular adenoma. A 41-year-old female, with a history of subtotal hysterectomy for uterine fibroma, presented for intermittent palpitations. TSH value was normal, but ultrasonography showed a mildly increased right lobe of 4.3 cm, with multiple bilateral micronodular masses. Conclusions. The thyroid ultrasound represents a very practical diagnostic method in daily gynaecological endocrinology. The detection of a nodule may be related to routine menopausal evaluation, may be associated with clinical examination for bone menopausal status or may be associated to thyroid function assessment if hot flushes mimic hyperthyroidism.