Management of the thyroid nodule

Abstract

The approach to the patient with a palpable solitary thyroid nodule remains controversial. In the rare patient with signs and symptoms suggestive of malignancy, the course of action is reasonably established. However, the patient with an asymptomatic solitary thyroid nodule presents a dilemma. The therapeutic alternatives range from suppressive medical therapy with serial examinations to surgical excision; therefore, to obviate unnecessary surgery, several diagnostic techniques and approaches have evolved which attempt to predict the presence of malignancy. A multitude of articles reflects the widespread disagreement among physicians regarding these diagnostic approaches. Thus, many questions still remain as to the proper management of patients with solitary nodules. The issue is further confounded by problems in assimilating and practically applying the results of the various studies, which often differ in their results. In this report, data regarding the prevalence of the solitary thyroid nodule are reviewed, and the clinical significance of the solitary thyroid nodule is discussed. The problem of management is examined in terms of the various diagnostic approaches to the solitary thyroid nodule: history and physical examination, laboratory tests, ultrasonography, thyroid suppressive therapy, scanning techniques, and fine-needle aspiration. The efficacy of each technique is critically evaluated with an emphasis upon the ability to distinguish benign from malignant disease. The overall aim of this report is to establish a reasonable diagnostic approach to the asymptomatic patient with the solitary palpable thyroid nodule, based upon a critical review of the literature.

Diffusion‐weighted images differentiate benign from malignant thyroid nodules

“…The incidence of malignancy is higher in solitary nodules than in multinodular goiters. The risk of malignancy in a euthryoid patient with a solitary nodule is estimated in most series to be 5%-10% with a range of 3.4%-29% (15,16).…”

Evaluation of cytopathological findings in thyroid nodules with macrocalcification: macrocalcification is not innocent as it seems

“…Also, vascularity can be determined by colour Doppler or power Doppler US. The use of US and US guided fine needle aspiration biopsy (FNAB) to assess thyroid nodules has reduced the number of unnecessary surgeries and increased the rate of diagnosis of thyroid cancer (4,5). The rate of accuracy of FNAB was reported up to 96%.…”

Pajzsmirigygöbök vékonytű-aspirációs citológiai vizsgálata. A Bethesda-rendszer (2008) minőségbiztosítása

“…kategóriá-ban 88,5% kórszövettani korreláció (pozitív prediktív érték) százalékos aránya egybeesik a nemzetközi elvárá-sokkal. A malignus citológiai csoportban a pozitív citoló-gia és pozitív kórszövettani megegyezés általában 84-99% között van [6,12]. Ebben a csoportban három téves pozitív esetünk volt, amelyek közül az egyikben hormonális atypia alapján döntöttünk tévesen a malignitás mellett.…”

“…Az FNAC az évek során a pajzsmirigygöbök kivizsgálásának sarokkövévé vált, és a pajzsmirigyrákra gyanús betegek diagnosztikus algoritmusában a legmegbízhatóbb teszt [4,5,6,7]. Az FNAC legfőbb klinikai indikációja a nem neoplasticus golyva és valódi neoplasia elkülönítése [8,9,10,11,12].…”