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.