CONTROVERSIES AND UPDATE IN OTOLARYNGOLOGY IN 2011 

Otorinolaringologia 2011 September;61(3):71-87

Copyright © 2011 EDIZIONI MINERVA MEDICA

language: English

Current management of a thyroid nodule

Tufano R. P. ¹, Noureldine S. I. ², Kandil E. H. ²

¹ Division of Head and Neck Cancer Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA; ² Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA

Thyroid nodules are commonly encountered by physicians from a diverse range of specialties and are becoming increasingly prevalent. The clinical importance of thyroid nodules rests with the need to exclude thyroid malignancy. We used current evidence and guidelines to discuss management options. Ultrasonography is often the first effective imaging modality employed to evaluate a thyroid nodule. Investigation should also include careful history and examination and thyroid function tests. Low serum thyroid stimulating hormone concentration indicates overt or subclinical hyperthyroidism, increasing the possibility that the nodule is hot or autonomous and requires radionuclide scan for assessment. Ultrasound guided fine needle aspiration biopsy provides direct specific information about the cytology of the nodule. Applying genetic markers to FNAB specimens offers more improved diagnostic accuracy. Thyroid nodules diagnosed as benign require follow-up with serial ultrasound examinations. Detailed management of indeterminate lesions is also discussed. Differentiated thyroid cancer (DTC) comprises the vast majority of all thyroid cancers. The primary mode of therapy for malignant nodules is surgical intervention, with total thyroidectomy. Tailored surgical treatment according to the extent of the disease is also discussed. Regional lymph node metastases are present at the time of diagnosis in 20-90% of patients with DTC, increasing the rates of mortality. Suspicious lymph nodes should undergo FNAB. For positive findings, appropriate additional compartment lymph node dissection should be preformed. The role of radioiodine therapy is discussed in our article.