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Thyroid nodules: diagnosis and management

Rosemary Wong, Stephen G Farrell and Mathis Grossmann
Med J Aust 2018; 209 (2): 92-98. || doi: 10.5694/mja17.01204
Published online: 16 July 2018

Summary

 

  • Thyroid nodules are common. Their importance lies in the need to assess thyroid function, degree of and future risk of mass effect, and exclude thyroid cancer, which occurs in 7–15% of thyroid nodules.
  • There are four key components to thyroid nodule assessment: clinical history and examination, serum thyroid stimulating hormone (TSH) measurement, ultrasound and, if indicated, fine-needle aspiration (FNA).
  • If the serum TSH is suppressed, a thyroid scan with 99Tc can distinguish between a solitary hot nodule, a toxic multinodular goitre or, less commonly, thyroiditis or Graves’ disease within a coexisting nodular thyroid. Scintigraphically cold nodules are evaluated in the same way as in the setting of normal or elevated serum TSH levels.
  • Thyroid ultrasonography should be performed only for palpable goitre and thyroid nodules and by specialists with expertise in thyroid sonography.
  • Routine thyroid cancer screening is not recommended, except in high risk individuals, as the detection of early thyroid cancer has not been shown to improve survival.
  • FNA may be performed for nodules ≥ 1.0 cm depending on clinical and sonographic risk factors for thyroid cancer.
  • FNA specimens should be read by an experienced cytopathologist and be reported according to the Bethesda Classification System.
  • Molecular analysis of indeterminate FNA samples has potential to better discriminate benign from malignant nodules and thus guide management.
  • Surgery is indicated for FNA findings of malignancy or indeterminate cytology when there is a high risk clinical context. Surgery may also be indicated for suspicion of malignancy; larger nodules, especially with symptoms of mass effect; and in some patients with thyrotoxicosis.

 

  • Rosemary Wong1
  • Stephen G Farrell2,3
  • Mathis Grossmann2,4

  • 1 Eastern Health, Melbourne, VIC
  • 2 Austin Health, Melbourne, VIC
  • 3 St Vincent's Hospital, Melbourne, VIC
  • 4 University of Melbourne, Melbourne, VIC

Correspondence: mathisg@unimelb.edu.au

Competing interests:

No relevant disclosures.

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