Management of the thyroid nodule

The approach to the patient with a palpable solitary thyroid nodule remains controversial. In the rare patient with signs and symptoms suggestive of malignancy, the course of action is reasonably established. However, the patient with an asymptomatic solitary thyroid nodule presents a dilemma. The therapeutic alternatives range from suppressive medical therapy with serial examinations to surgical excision; therefore, to obviate unnecessary surgery, several diagnostic techniques and approaches have evolved which attempt to predict the presence of malignancy. A multitude of articles reflects the widespread disagreement among physicians regarding these diagnostic approaches. Thus, many questions still remain as to the proper management of patients with solitary nodules. The issue is further confounded by problems in assimilating and practically applying the results of the various studies, which often differ in their results. In this report, data regarding the prevalence of the solitary thyroid nodule are reviewed, and the clinical significance of the solitary thyroid nodule is discussed. The problem of management is examined in terms of the various diagnostic approaches to the solitary thyroid nodule: history and physical examination, laboratory tests, ultrasonography, thyroid suppressive therapy, scanning techniques, and fine-needle aspiration. The efficacy of each technique is critically evaluated with an emphasis upon the ability to distinguish benign from malignant disease. The overall aim of this report is to establish a reasonable diagnostic approach to the asymptomatic patient with the solitary palpable thyroid nodule, based upon a critical review of the literature.