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Management of Thyroid Nodules.

Mehmet Uludag1, Mehmet Taner Unlu1, Mehmet Kostek1

  • 1Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye.

Sisli Etfal Hastanesi Tip Bulteni
|October 30, 2023
PubMed
Summary

Thyroid nodules are common, with most being benign. Evaluation involves thyroid stimulating hormone (TSH) tests, ultrasound, and fine needle aspiration biopsy (FNAB) using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC).

Keywords:
Imagingrisk classificationthyroid noduletreatment management

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Area of Science:

  • Endocrinology
  • Radiology
  • Oncology

Background:

  • Thyroid nodules are highly prevalent, detected via palpation or imaging, with a malignancy rate of 7-15%.
  • Incidental detection is common during routine examinations or unrelated imaging studies.
  • Clinical evaluation is crucial for all detected thyroid nodules.

Purpose of the Study:

  • To outline the diagnostic pathway for evaluating thyroid nodules.
  • To discuss the role of various imaging and biopsy techniques.
  • To highlight risk stratification systems and modern molecular testing applications.

Main Methods:

  • Thyroid stimulating hormone (TSH) testing to assess thyroid function.
  • Radionuclide thyroid scan for hyperfunctioning nodules.
  • High-resolution ultrasonography (US) for nodule evaluation.
  • Fine needle aspiration biopsy (FNAB) guided by US risk classification.
  • Cytological analysis using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC).

Main Results:

  • Ultrasonography (US) is the most sensitive imaging modality for thyroid nodules.
  • The Bethesda System (TBSRTC) provides a standardized 6-category cytological classification.
  • Molecular tests on FNAB specimens are increasingly used for Bethesda III and IV nodules to guide treatment.
  • Treatment strategies vary based on malignancy risk, including observation, surgery, and ablation.

Conclusions:

  • A systematic approach involving TSH, US, and FNAB with TBSRTC classification is essential for thyroid nodule evaluation.
  • Risk stratification systems and molecular testing aid in personalized treatment decisions.
  • Minimizing unnecessary diagnostic surgery through molecular testing is a key advancement.