Surgical therapeutic planning options in nodular goiter

Area of Science:

• Endocrinology
• Surgical Oncology
• Diagnostic Imaging

Background:

• Nodular goiter presents a wide spectrum, from asymptomatic nodules to large goiters causing symptoms.
• Diagnosis relies on functional and morphological evaluation, including serum TSH, ultrasound, and fine needle aspiration (FNA).

Purpose of the Study:

• To propose a clinical classification for nodular goiter.
• To outline diagnostic and therapeutic strategies, including non-surgical and surgical options.
• To guide treatment decisions based on nodule characteristics and patient presentation.

Main Methods:

• Utilizing serum thyroid-stimulating hormone (TSH) levels.
• Employing ultrasound (US) and other imaging procedures.
• Performing fine needle aspiration (FNA) cytology for diagnosis.

Main Results:

• A clinical classification can guide alternative therapies like TSH suppressive treatment, 131I therapy, or percutaneous ethanol injection therapy (PEIT) for benign lesions.
• Surgery is indicated for pressure symptoms, hyperthyroidism, or indeterminate cytology.
• Surgical approaches (lobectomy, total thyroidectomy) are tailored to nodular goiter type (uninodular vs. multinodular).

Conclusions:

• Nodular goiter management requires a tailored approach based on clinical presentation, imaging, and cytology.
• Treatment selection, including surgery or alternative therapies, should be individualized and discussed with the patient.
• Frozen section analysis aids intraoperative decision-making during hemithyroidectomy to exclude malignancy.