Thyroid nodules - Stepwise diagnosis and management

Abstract

thyroid nodules are common in clinical practice. they may be solitary within a "normal" thyroid gland or dominant within a multinodular goiter. the incidence of thyroid nodules has been on the rise in recent decades, mainly due to the wider use of neck imaging. therefore, the incidental finding of a thyroid nodule in an asymptomatic patient is not rare. the differential diagnosis of a thyroid nodule is crucial, as malignancy necessitates surgery, while strict patient follow-up is necessary in the case of benignity. Fine-Needle Aspiration biopsy is considered to be the "gold standard" in the selection of patients for surgery. Ultrasonography (Us) can be used to determine changes in the size of nodules during follow-up or to detect recurrent lesions in patients suspected for thyroid malignancy, although there are no specific Us findings that suggest malignancy. surgery is mandatory in cytologically malignant nodules or in cases suspicious for malignancy. the definite diagnosis and consequent therapy is based on the histological findings after surgery. In this review we present an approach to thyroid nodules in five distinct steps, from the clinical or incidental finding of a nodule to the suggested treatment baselines.

Management of Thyroid Nodules

“…FNAC is considered as the 'gold standard' in the management of thyroid nodules [1]. It is a simple, cost-effective, accurate, safe and minimally invasive procedure which can be done in the outpatient setting.…”

“…Benign cytology: The patients with benign cytology and low risk factors may still need follow up for a further 6-18 months considering 5% false negative FNAC results [1,2]. US +/-FNAC need to be repeated if nodule grows significantly.…”

“…This could be due to several factors including, better imaging and histological techniques and diagnosis of micro carcinomas. Thyroid cancer accounts for 1% of all malignancies and 0.5% of death from malignancies [1,2].…”

Pre-operative diagnosis of thyroid cancer: Clinical, radiological and pathological correlation

“…A thyroid nodule is a discrete lesion within the parenchyma which can be detected either by palpation or ultrasound 1 . Thyroid nodules may be neoplastic or non-neoplastic with neoplastic nodules either benign or malignant (Table 1).…”

Contributory Factors to Hemorrhage After Ultrasound-Guided Fine Needle Aspiration of Thyroid Nodules with an Emphasis on Patients Taking Antithrombotic or Anticoagulant Medications

“…Recently, thyroid nodules have been detected with increasing frequency as the use of ultrasound (US) has increased for evaluating the thyroid gland (1)(2)(3). US-guided fine needle aspiration (US-FNA) biopsy is a safe, accurate, and cost-effective method for the preoperative evaluation of thyroid nodules (2,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”