Management of the Solitary Thyroid Nodule

The Alfred Hospital, Monash University Endocrine Surgery Unit, Melbourne, Australia.
The Oncologist (Impact Factor: 4.87). 03/2008; 13(2):105-12. DOI: 10.1634/theoncologist.2007-0212
Source: PubMed


Thyroid nodules are common, with up to 8% of the adult population having palpable nodules. With the use of ultrasound, up to 10 times more nodules are likely to be detected. Increasing numbers of nodules are being detected serendipitously because of the rising use of imaging to investigate unrelated conditions. The primary aim in investigating a thyroid nodule is to exclude the possibility of malignancy, which occurs in about 5% of nodules. This begins with a thorough history, including previous exposure to radiation and any family history of thyroid cancer or other endocrine diseases. Clinical examination of the neck should focus on the thyroid nodule and the gland itself, but also the presence of any cervical lymphadenopathy. Biochemical assessment of the thyroid needs to be followed by thyroid ultrasound, which may demonstrate features that are associated with a higher chance of the nodule being malignant. Fine-needle aspiration biopsy is crucial in the investigation of a thyroid nodule. It provides highly accurate cytologic information about the nodule from which a definitive management plan can be formulated. The challenge remains in the management of nodules that fall under the "indeterminate" category. These may be subject to more surgical intervention than is required because histological examination is the only way in which a malignancy can be excluded. Surgery followed by radioactive iodine ablation is the mainstay of treatment for differentiated thyroid cancers, and the majority of patients can expect high cure rates.

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    • "Thyroid cancers occur in approximately 5% of all thyroid nodules independent of their size.[3]The recent data suggest that the incidence of thyroid malignancy is increasing over the years.[1,3]The occurrence of malignancy is more in solitary thyroid nodules (STN) compared to multinodular goiter.[1,7,8]The "
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    ABSTRACT: Thyroid nodules are common. They can be either benign or malignant. Solitary thyroid nodules (STN) have a high likelihood of being malignant. They should be characterized properly for optimum management. In this study, we have analyzed our departmental data over a period of 5 years. All the patients who presented to the outpatient department with a clinically detected STN were included in the study group. Our approach was individualized. Preoperative ultrasonography (USG) and fine-needle aspiration cytology were planned in all these patients. Hemi thyroidectomy and total thyroidectomy with and without neck dissection were performed wherever appropriate. There were 162 cases of clinically detected STN. USG findings were available in 146 cases. Postoperative histopathology was reported as malignant in 58 cases. Malignant STN was more likely in males. Ultrasonographically detected solid STN were more prone for malignancy as compared to multinodular goiter (P = 0.000) Presence of micro calcification and cervical lymphadenopathy were more commonly noted in malignant thyroid swellings. Solitary thyroid nodules do have a high likelihood of harboring a malignancy. Solid echogenicity, micro calcification and cervical lymphadenopathy on USG were seen more frequently in malignant nodules.
    Full-text · Article · Jul 2015
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    • "Solitary thyroid nodules are unlikely to be malignant, which corresponds for 5% of these patients.[1112] The Bethesda System for Reporting Thyroid Cytopathology group has identified six diagnostic categories in which the risk of malignancy increases respectively. "
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    ABSTRACT: Background:Fine-needle aspiration cytology (FNAC) in the diagnosis of thyroid nodules is an easy and cost-effective method. The increase in malignancy rates of the excised nodules due to the high sensitivity and specificity rates of the FNAC is remarkable.Aim:The aim of this study was to assess the effectiveness of FNAC in the evaluation of thyroid nodules by comparing the results with histopathologic evaluation and comparing the consistency of the results with the literature.Materials and Methods:In this study, 1607 FNACs of 1333 patients which were classified according to the Bethesda system and 126 histopathological evaluations obtained from this group were evaluated. The mean age of the patients was 51.24 (range: 17-89, 17% male and 83% female). The sensitivity, specificity, positive and negative predictive values, and accuracy rates were evaluated.Results:The sensitivity was 87.1% and specificity was 64.6%. The positive and negative predictive value and accuracy rates were 76.1%, 79.5%, and 77.3%, respectively.Conclusions:In our study, the evaluation of thyroid FNAC samples with Bethesda system highly correlated with the results of histopathological diagnosis. However, combination of additional and advanced diagnostic methods such as immunocytochemical studies and molecular pathology techniques enhance the prognostic value of FNAC in patients with atypia of undetermined significance or follicular lesion of undetermined significance, lesions suspicious for malignancy, and suspected follicular neoplasm.
    Full-text · Article · Apr 2014 · Journal of Cytology
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    • "and it was 4 times higher in females than that in males. The incidence of nodular goiter is at a higher level, and related studies reveal the thyroid nodules are found in 4.0~8.0% of adults at palpation and the incidence of thyroid nodular disease is 30~50% in general population at ultrasonography 1-4. At the early stage of nodular goiter, the nodule is small and the compression symptoms are not evident. "
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    ABSTRACT: Objective: To summarize the experience in the peri-operative treatment of giant nodular goiter. Methods: A total of 123 patients with giant nodular goiter sized 6~20 cm were admitted into our hospital from 1990 to 2011 and the clinical data were retrospectively analyzed. These patients underwent total or subtotal thyroidectomy. Results: All patients underwent surgical intervention. Unilateral subtotal thyroidectomy was performed in 40 patients, unilateral total thyroidectomy in 1 patient, bilateral subtotal thyroidectomy in 79 patients, and unilateral total thyroidectomy, removal of entire isthmus and contralateral subtotal thyroidectomy in 3 patients. Nodular goiter was pathologically proven post-operatively. No short-term complications such as dyspnea or thyroid storm were found postoperatively. Post-operative follow up was done for 9 months to 6 years and no recurrence was observed. Conclusion: Comprehensive pre-operative preparation, pre-operative evaluation, complete exposure of the operative field, meticulous operation, effective control and prevention of hemorrhage and prevention against damage to superior and recurrent laryngeal nerves are crucial for the successful surgical intervention of giant nodular goiter.
    Preview · Article · Oct 2012 · International journal of medical sciences
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