The Diagnosis and Management of Thyroid Nodules A Review
Top Cited Papers
- 6 March 2018
- journal article
- review article
- Published by American Medical Association (AMA) in Jama-Journal Of The American Medical Association
- Vol. 319 (9), 914-924
- https://doi.org/10.1001/jama.2018.0898
Abstract
IMPORTANCE Thyroid nodules are common, being detected in up to 65% of the general population. This is likely due to the increased use of diagnostic imaging for purposes unrelated to the thyroid. Most thyroid nodules are benign, clinically insignificant, and safely managed with a surveillance program. The main goal of initial and long-term follow-up is identification of the small subgroup of nodules that harbor a clinically significant cancer (approximate to 10%), cause compressive symptoms (approximate to 5%), or progress to functional disease (approximate to 5%). OBSERVATIONS Thyroid function testing and ultrasonographic characteristics guide the initial management of thyroid nodules. Certain ultrasound features, such as a cystic or spongiform appearance, suggest a benign process that does not require additional testing. Suspicious sonographic patterns including solid composition, hypoechogenicity, irregular margins, and microcalcifications should prompt cytological evaluation. Additional diagnostic procedures, such as molecular testing, are indicated only in selected cases, such as indeterminate cytology (similar to 20%-30% of all biopsies). The initial risk estimate, derived from ultrasound and, if performed, cytology report, should determine the need for treatment and the type, frequency, and length of subsequent follow-up. Management includes simple observation, local treatments, and surgery and should be based on the estimated risk of malignancy and the presence and severity of compressive symptoms. CONCLUSIONS AND RELEVANCE Most thyroid nodules are benign. A diagnostic approach that uses ultrasound and, when indicated, fine-needle aspiration biopsy and molecular testing, facilitates a personalized, risk-based protocol that promotes high-quality care and minimizes cost and unnecessary testing.Keywords
This publication has 75 references indexed in Scilit:
- The Impact of Benign Gene Expression Classifier Test Results on the Endocrinologist–Patient Decision to Operate on Patients with Thyroid Nodules with Indeterminate Fine-Needle Aspiration CytopathologyThyroid®, 2012
- Preoperative Diagnosis of Benign Thyroid Nodules with Indeterminate CytologyThe New England Journal of Medicine, 2012
- The surgical management of goiter: Part II. Surgical treatment and resultsThe Laryngoscope, 2010
- Evaluation of a Thyroid NoduleOtolaryngologic Clinics of North America, 2010
- Fine‐needle aspiration of follicular patterned lesions of the thyroid: Diagnosis, management, and follow‐up according to National Cancer Institute (NCI) recommendationsDiagnostic Cytopathology, 2010
- Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examinationEuropean Journal of Clinical Investigation, 2009
- Determination of calcitonin levels in C-cell disease: clinical interest and potential pitfallsNature Clinical Practice Endocrinology & Metabolism, 2009
- Benign and Malignant Thyroid Nodules: US Differentiation—Multicenter Retrospective StudyRadiology, 2008
- Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluationCancer, 2007
- Nonsurgical approaches to the management of thyroid nodulesNature Clinical Practice Endocrinology & Metabolism, 2006