PAEA Surgery End Of Rotation (EOR) Practice Exam

Which type of thyroid nodule is more likely to be malignant?

1. Hot nodules

2. Cold nodules

3. Both have equal risk

4. Neither type

The correct answer is: Cold nodules

Cold nodules are more likely to be malignant compared to hot nodules. In the context of thyroid nodules, a hot nodule refers to one that is hyperfunctioning and takes up radioactive iodine during imaging studies, indicating that it is producing thyroid hormone. These hot nodules are usually benign, such as adenomas, and have a lower risk of malignancy. Conversely, cold nodules do not uptake radioactive iodine, which can be indicative of a non-functioning nodule. A higher proportion of cold nodules are associated with malignancy because they may represent either a benign condition, such as a cyst or adenoma, or a malignant process, including thyroid cancer. Therefore, the presence of a cold nodule raises clinical suspicion for malignancy, prompting further evaluation and possible biopsy to determine the nature of the nodule. This understanding reinforces why cold nodules are particularly concerning in terms of potential malignancy and underscores the importance of assessment and management strategies for thyroid nodules in clinical practice.