Thyroid incidentalomas. Prevalence, diagnosis, significance, and management

Thyroid incidentalomas are common, always impalpable, often less than 1.5 cm in size, and frequently benign. The authors recommend that low-risk patients with incidentalomas be followed up with clinical palpation in 6 to 12 months and not be subjected to routine testing with US-FNA. In the authors' strategy, fine-needle aspiration is reserved for an impalpable nodule and is performed under ultrasonographic guidance in the high-risk group of patients in whom either the imaging features or the clinical history is worrisome for malignancy. It does not seem necessary, practical, or cost-effective to perform biopsy or to excise surgically all impalpable nodules. Because of the high prevalence of thyroid incidentalomas, most of which are benign, a nonsurgical approach is logical.