Management of Thyroid Nodules

Abstract

Thyroid nodules are common in ENT practice with a prevalence of 4-8% on clinical palpation and up to 8 -76% when evaluated with an Ultrasound Scan (US). When the nodule size is 1 cm or more it becomes clinically palpable. Approximately 5% of thyroid nodules are malignant. Detailed history and clinical examination are important in the evaluation of patients with thyroid nodules. Though US and Fine Needle Aspiration Cytology (FNAC) are useful investigations for thyroid nodules, it may not be possible to arrive at a diagnosis in all cases. Several US features suspicious for malignancy have been identified. Classification systems based on the FNAC results have been devised and are useful in surgical decision-making and management. Molecular testing can be used in nodules with FNAC results of atypia or follicular neoplasm, to stratify the risk of cancer. Patients with benign cytology may need a lobectomy for compressive symptoms or cosmetic concerns. Follicular lesions on FNAC need a diagnostic lobectomy followed by completion thyroidectomy, if proven to be malignant. Majority of the Differentiated Thyroid Cancers (DTC) will require total thyroidectomy, radio-active ablation and suppressive thyroxine therapy.