Approach to Solitary Thyroid Nodules in Adults

Thyroid nodules are exceedingly common in the general population and their increasing incidence appears to be secondary to incidental finding on imaging. Nonetheless, due to the potential for malignancy and thyroid dysfunction, most thyroid nodules require further investigation. Although there are no current guidelines for thyroid cancer screening in asymptomatic patients, a thorough history and physical which focuses on risk factors can serve as a good starting point during the evaluation of a thyroid nodule. This is followed by diagnostic analysis with thyroidstimulating hormone; as well as thyroid scintigraphy, T4, and T3 when indicated. Ultrasound is the gold standard diagnostic imaging modality for suspicious thyroid nodules and can provide further information on malignancy potential and the need for fine need aspiration (FNA). Thyroid nodules can then be further classified on a spectrum ranging from benign to malignant based on a combination of ultrasound and FNA findings. Patients with thyroid nodules that are malignant, suspicious for malignancy, or intermediate lesions should be referred on to a surgeon for potential operative intervention. It is important for primary care providers to be well versed in the work-up and initial evaluation of thyroid nodules as they are often the first provider a patient will present to. This review article serves to refresh and guide the primary care provider through the initial evaluation and management of thyroid nodules.