Solitary nodule thyroid: diagnosis and management

Abstract

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Solitary nodule can be a true solitary nodule or a dominant nodule of multinodular goitre or ectopic thyroid or unilateral agenesis. Solitary nodule can be benign or malignant. Purpose of evaluation is to differentiate between the two. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A prospective study of solitary nodule thyroid (STN) patients presenting to ENT outpatient department, for a period of 3 years from September 2012 to 2015. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Out of 67 patients<strong> </strong>enrolled into study, 53 patients had benign true STN, 9 patients had multinodular goiter (MNG) presenting as solitary nodule and 5 had malignant nodule (7.46%). Among the benign nodules, 25 patients had small solitary nodule (<4 cm size). They were treated medically and followed-up for a period of 1 year. 28 patients with large benign solitary nodules (>4 cm size) were taken up for surgery directly. Hemithyroidectomy was done in benign STN patients (39 patients) and total thyroidectomy was done in malignant nodule and MNG patients and followed-up by lifelong L-T<sub>4 </sub>therapy. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Small benign solitary nodules regress with medical therapy alone. In large solitary nodules, and in those nodules not regressing with medical therapy, hemithyroidectomy is adequate. In MNG and malignant nodules, total thyroidectomy is advocated. Hemithyroidectomy and total thyroidectomy patients were followed - up with suppression and supplementation therapy respectively.</span><span lang="EN-IN">This area being fluorotic belt, there is an increased prevalence of goiter. This study gives a concise guideline in evaluation and management of STN for goiter endemic areas.</span></p><p class="abstract"> </p>

Clinical study of thyroid swellings

“…In our study, on clinical examination and correlating it with ultrasonographic findings, it was found that majority of the patients presented with bilateral swelling (54%), followed by unilateral swelling (34%) and few (12%) had swelling in the midline, which differed from other studies with swelling frequent unilaterally. In our study in unilateral swellings, the swelling was frequently found in right lobe of thyroid (22%) and only 12% swelling were present in left thyroid lobe, which was similar to the findings of Vyas et al and Deepthi et al 7,8 On USG, in our study, colloid nodule was the commonest thyroid swelling followed by MNG, which differed from that found by Santosh et al…”

Clinical Evaluation and Management of Solitary Nodule Of Thyroid in Euthyroid Patients

“…Also, 7.5% had total thyroidectomy with nodal dissection. Deepthi Met al [7] in their study similar to our study observed that hemithyroidectomy was done in 74% of benign STN 65patients and a total thyroidectomy was done in malignant nodule and MNG patients and followed-up by lifelong L-T4 therapy. They concluded that "Small benign solitary nodules regress with medical therapy alone.…”

“…In our study only 13.8% of the nodules were malignant. The incidence of malignancy was only 7.46% in the study by Deepthi Met al [7]. In the study by FNAC showed that 14% of the nodules were malignant.…”