Management of thyroid nodules. I: History and physical examination, blood tests, x‐ray tests, and ultrasonography

Abstract

The approach to the management of the thyroid nodule remains controversial. Confusion exists because virtually any thyroidal disease can present as a clinically solitary nodule which means there is no uniformity regarding natural history, incidence, prevalence, epidemiology, and pathophysiology.. The variety of definitions of thyroid nodules and thyroid carcinoma and the different modes of study selection and individual bias add to the confusion. Diagnostic approaches have not yielded a completely reliable technique to differentiate benign from malignant thyroidal disease. A history of neck irradiation of cervical lymphadenopathy significantly increases the chance of thyroid malignancy, but other parameters of the history or physical examination as well as blood tests are unreliable. Ultrasound displays anatomic but not histologic features. X-ray techniques (plain films, computed tomographic scans, xeroradiography, chest x-ray, barium swallow, lymphography, and angiography) have been used to visualize thyroid nodules, with some techniques proving more useful than others.

Trends in Thyroid Imaging

“…In view of this probable selection bias, the frequency of ma lignancy probably averages at least 10%. Such a figure which we also obtained through our own experience agrees with sim ilar conclusions presented by others, like those from Aschcraft and Van Herle [6],…”

“…Their ability to differentiate be tween benign and malignant thyroid nodules remains doubtful [ 1,2,5,6], The same holds true for gallium-67 citrate.…”

When Fine-Needle Aspiration Biopsy Cannot Exclude Papillary Thyroid Cancer

“…Eighty-four percent are nonfunctioning (cold), 10.5% have uniform tracer uptake (warm), and 4% are hyperfunctioning (hot). 18,19 Cancer has been reported in approximately 16% of cold nodules, 9% of warm nodules, and less than 1% of hot nodules. 20 We also sought to determine if there were specific cytologic features that could help differentiate benign from malignant disease.…”

A cytopathological study of malignant thyroid lesions and its implications in a referral center.

“…TBSRTC recommends six diagnostic categories which includes -Non diagnostic, benign, atypia of undetermined significance or follicular lesion of undetermined significance, follicular neoplasm or suspicious for a follicular neoplasm, suspicious for malignancy and malignant. Malignancy is more common in solitary nodule and the prevalence of malignancy in solitary cold nodules ranges from 10% to 44.7% [10] . Malignant thyroid tumors are broadly divided into well differentiated-PTC and follicular carcinoma, poorly differentiated-insular carcinoma and undifferentiatedanaplastic carcinoma.…”