Approach to Thyroid Nodules: Diagnosis and Treatment

Abstract

Thyroid nodules (TNs) are prevalent and found in up to 50% of individuals. While most TNs are benign, some can be malignant. The evaluation of TNs is crucial to rule out malignancy and identify those requiring surgical intervention. This study aimed to clarify the reported prevalence of TNs, focusing specifically on their various types, assessment and diagnostic processes, current evaluation methods, and evidence-based management. It also provides recommendations for follow-up. TNs are typically found during physical exams or incidentally during imaging procedures. Routine laboratory and clinical evaluations of TNs are common. Ultrasound is the preferred imaging method to determine if a TN needs a biopsy. Fine-needle aspiration (FNA) is crucial in deciding whether surgery or surveillance is necessary. TNs that show suspicious features on the ultrasound may require cytologic analysis to assess the risk of malignancy. The effectiveness of several supplementary molecular tests is still uncertain, although some studies report promising results. The management and treatment approach for TNs primarily depends on the results of FNA cytology and ultrasound characteristics. The optimal treatment strategy for TNs ranges from straightforward follow-ups for low-risk cases to surgical intervention for high-risk patients. Rather than adopting a uniform approach, clinicians should assess each patient on a case-by-case basis using current knowledge and a collaborative, multidisciplinary method.

Keywords: bethesda; fna; malignant; nodules; tsh; ultrasonography.

Figure 1. Ultrahigh resolution optical coherence tomography

Normal thyroid demonstrates well-organized round to oval thyroid follicles (f). Colloid with various densities was observed under (a) en face OCT and (b) OCM. The follicles are lined by a single layer of epithelium (arrows), which are clearly seen in the OCM image (b); c and d are corresponding H&E slides. OCT - optical coherence tomography; OCM - optical coherence microscopy Permission to use the figure in this review article has been obtained from Society of Photo-optical Instrumentation Engineers, International Biomedical Optics Society, Journal of Biomedical Optics [38].

Figure 2. Treatment approach to thyroid nodule

Permission to use the figure in this review article has been obtained from Annals of Surgical Oncology, Springer Nature [43] ND - non-diagnostic; TT - thyroxine treatment; US FNA - ultrasound fine-needle aspiration; AUS - atypia of undetermined significance; SFN/SHCN - suspicious for follicular neoplasm/ suspicious for Hurthle cell neoplasm; CLND - central lymph node dissection