[Thyroid nodular disease]

The thyroid gland is fairly homogeneous but nodules are frequent. Nodules greater than 1.0 cm are usually palpable, but non-palpable nodules, smaller than 1.0 cm are far more frequent. Thyroid nodular disease, the etiology of which is multifactorial, encompasses lesions, from the small incidentaloma to large multinodular intrathoracic goiter. The main diagnostic issues are related to the functional and morphological characterization using TSH measurements and image methods. Fine needle aspiration biopsy is the method of choice to rule out malignancy, the incidence of which is similar in single or multinodular goiter (MNG). MNG treatment can be surgical or radioactive iodine (131I) could be indicated if the 131I uptake is adequate. It is likely that the use of recombinant human TSH (rhTSH) will strongly change the application of 131I in MNG treatment. The benign single thyroid nodule, "cold" or "hot" at scintigraphy, can be treated with percutaneous ethanol injection. The "hot" nodule can also be treated by surgery or 131I.