الفهرس 
Introduction and Aim of the work
Chapter 1: Surgical anatomy of the thyroid glandOnly 14 pages are availabe for public view
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Abstract
Diagnosis of malignant thyroid nodules shows a large spectrum of diagnostic modalities and management strategies.
This work aimed to assessment the best and the most accurate diagnostic work up done for diagnosis malignant thyroid in patients with solitary or dominant thyroid nodules, and to perform the most effective treatment with less complications without the need for secondary surgical intervention.
This work comprised 30 patients with thyroid nodule who were candidates for surgical interference. These patients were presented to General Surgery department in Assuit University during the period of this study ,suffering from thyroid nodule which was manifested by swelling in front of the neck with or without rapid growth or thyrotoxic manifestation or both.
30 patients underwent thyroid function tests, neck ultrasound and fine needle aspiration cytology. Preoperative assessment for these patients was done to identify the most accurate diagnostic work up, especially neck ultrasound and fine needle aspiration cytology.
This study point out to finding the best diagnostic guidelines. Our study illustrated that the first step in diagnosis the clinical type of the thyroid nodule is thyroid function tests to exclude toxic nodules . Then the role of neck ultrasound comes to assess the nodule if it is benign or malignant and solitary or dominant. It also detects the malignant featuring lymph nodes. The last step is FNAC especially in large-sized thyroid nodules, small size thyroid nodules with clinical picture suggesting malignancy and malignant featuring ultrasound findings .
The surgical treatment depends mainly on the result of FNAC , if it is not sufficient or non-diagnostic , it is better to repeat FNAC sampling. However in our study thyroid function tests and neck ultrasound proved the benign nature of the nodule that showed non-diagnostic result, so hemithyroidectomy was enough for that case without the need for resampling. If FNAC result was indeterminate, we considered the age of the patient, the clinical data and ultrasound findings to choose the appropriate surgical treatment (hemithyroidectomy for benign featuring lesions or total thyroidectomy for malignant featuring lesions).
If FNAC result was benign, neck ultrasound will be our reference in taking the decision. If ultrasound showed the nodule as solitary one, hemithyroidectomy will be our option, but if it showed the nodule dominant (multinodular goiter) , subtotal thyroidectomy will be suitable for dominant colloid nodules and total thyroidectomy will be suitable for dominant toxic nodules.
If FNAC result was suspicious, we search for suggestive clinical data and sonographic findings that can ensure the previous malignant result of the nodule
If FNAC result was malignant, total thyroidectomy with or without lymph node dissection (according to the clinical examination if there is sizable enlarged cervical lymph node or sonographic findings of enlarged cervical lymph nodes with loss of their hilum) after metastatic work up by performing imaging studies on susceptible organs that could be affected.
The most important diagnostic modality of thyroid nodule is fine needle aspiration cytology, but for more accuracy in diagnosis and treatment the thyroid nodule, other factors should be considered e.g. clinical data including the patient`s age, thyroid function tests and neck ultrasound.
1 case was reported to have papillary carcinoma and underwent subtotal thyroidectomy. Patient later on underwent completion without block neck dissection.
At the end we discuss different opinions and studies that are the most recent in the international medical field studying neck ultrasound, fine needle aspiration cytology in diagnosis the solitary thyroid nodules with pointing out to the few opinions about their accuracy to diagnose and treat malignant and benign thyroid nodules.