The Management of Thyroid Nodules

Abstract

ReviewThyroid nodules are extremely common and are detected in 3%-7% of the general population by palpation and in 70% of the population by ultrasonography (USG). Approximately 5%-15% of these nodules are malignant. Therefore, in nodule examination, our primary aim is to detect malignant nodules. Besides the medical history and the findings of the physical examination, USG and fine-needle aspiration biopsy (FNAB) are the most commonly used methods to examine these nodules. Ultrasound-guided FNAB and on-site assessment of FNA specimens are suggested to decrease false negative and non-diagnostic test results. FNAB results in the "atypia of undetermined significance" group is challenging in the follow-up or treatment of the nodule. In this group, to differentiate the malignant nodules, other developing methods, such as analyzing molecular genetic markers, protein markers, and elastography, are generally studied. However, these methods are not used in a routine nodule examination because of cost-benefit analysis. Keywords

Comparison of conventional smear and liquid-based cytology in adequacy of thyroid fine-needle aspiration biopsies without an accompanying cytopathologist

“…Thyroid function tests and ultrasonography are routinely performed in the process of diagnosis of TNs, but the exact discrimination between benign and malignant nodules cannot be made using these methods. [ 1 , 6 ] Fine-needle aspiration biopsy (FNAB) is the “gold standard” method in distinguishing malignant nodules from benign nodules with >95% negative predictive value for benign cytology and >99% positive predictive value for malignant cytology. [ 7 ] FNAB is routinely performed to exclude malignancy in nodules which have increased risk for malignancy according to different classification systems depending on size and suspicious findings on ultrasound (US) examination.…”

TI-RADS Diagnostic Performance: Which Algorithm Is Superior and How Elastography and 4D Vascularity Improve the Malignancy Risk Assessment

“…Scintigraphic evaluation of the thyroid gland was performed in patients with suspicion of hot nodules (TSH below the normal range). Autonomously functioning nodules were found in nine cases and given their very unlikely tendency for malignancy (<1%), these cases were also excluded from the study [16][17][18]. For patients with multinodular goiter, the nodule with the most suspicious US pattern was chosen for inclusion in the study.…”