Algorithmic Approach to Thyroid Nodules - Review

  • Bayram Veyseller
  • Fadlullah Aksoy
  • Fatma Gülüm İvgin Bayraktar

Med Bull Haseki 2010;48(1):1-8

Thyroid nodule is a commonly seen problem. They are found in 4%-8% of adults by palpation. Increasing number of nodules are being recognized incidentally due to the wider use of neck imaging.The primary goal in investigating a thyroid nodule is to eliminate the possibility of malignancy. Malignancy requires surgical intervention, but in benign conditions, strict follow-up of the patient can be enough in some cases. Evaluation of the thyroid nodule begins with learning the exact family history and previous exposure to radiation. Clinical examination of the neck should focus on the thyroid gland and presence of any cervical lymphadenopathy. Ultrasonography and the other imaging techniques applied to the thyroid gland can be used to determine the changes in nodule size and its relations with the surrounding structures. There is no specific US finding that suggests malignancy. Fine-needle aspiration biopsy (FNAB) is crucial and gold standard in the selection of the patients for surgery. FNAB provides highly accurate cytological information about thyroid nodules and therefore, definitive management plan can be designed. Surgery is obligatory in cytologically malignant nodules or in the nodules suspicious for malignancy. The definitive diagnosis and consequent therapy are based on the histological results after surgery. In this review, we present an algorithmic approach to the evaluation of the thyroid nodule.

Keywords: Fine-needle aspiration biopsy, goitre, thyroid nodule, thyroid carcinoma, thyroid adenoma, algorithmic approach

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