Small (<10 mm) thyroid nodules; how aggressively should they be managed?

Most commonly, an aggressive management (including surgery) is recommended for thyroid nodules measuring >10 mm. The aim of this review is to present currently available data regarding indications for aggressive treatment of small (<10 mm) thyroid nodules. Clinical factors (history of neck irradiation; extremes of age, i.e. children or elderly patients; family history of thyroid cancer, specifically medullary thyroid cancer, and MEN 2 A or B or familial medullary thyroid cancer; rapid growth of nodule), findings from routine laboratory investigation (increased thyroglobulin or calcitonin levels) or genetic testing (specific RET gene mutations), echomorphological characteristics of the suspicious nodule, and the result of fine-needle aspiration (FNA) should be combined to select those patients with small thyroid nodules, who should be treated surgically. In conclusion, nodule size per se is not an absolute criterion of safety. Aggressive treatment may be indicated in the presence of suspicious clinical/laboratory and/or ultrasound (US) findings. US-guided FNA should be performed when malignancy is a concern, regardless of nodule size, to avoid missing or undertreating a curable cancer.