Follow‐up of large thyroid nodules without surgery: Patient selection and long‐term outcomes

Abstract

Background The management of large thyroid nodules remains controversial. Mandatory resection is recommended by some authors. Methods All patients with thyroid nodules ≥3 cm between January 2009 and January 2013 were followed until August 2017. Follow‐up data were collected using an integrated hospital‐community system. Results A total of 141 nodules were included. Of these, 37/141 (26%) nodules were initially referred to surgery, resulting in a 32% malignancy rate (12/37). The remaining 104/141 (74%) were referred to follow‐up. During the follow‐up period, 24 additional operations were done, resulting in a 4% malignancy rate (1/24). An indication of nonbenign cytology was significantly associated with malignancy compared with other indications. Median follow‐up was 53.5 months. No patient developed regional or distal diseases. The mean change in nodule size during the follow‐up period was a 7% reduction, with no significant trend of change over time. Conclusion Careful patient selection based on clinical, sonographic, and cytologic features can reduce diagnostic surgery allowing for safe follow‐up of large thyroid nodules without surgery.