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Management of Indeterminate Thyroid Nodules: A Model Comparing Surgery, Molecular Testing, and Observation.
Alexandra Welschmeyer1, Maxwell Kligerman2, Julia Noel3
1Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Summary
For indeterminate thyroid nodules (Bethesda Classes III-IV), molecular testing offers the most benefit across all ages. However, clinical differences between observation, molecular testing, and surgery are minimal, favoring individualized treatment plans.
Area of Science:
- Endocrine Surgery
- Decision Analysis
- Thyroid Nodule Management
Background:
- Optimal management of indeterminate thyroid nodules (Bethesda Classes III-IV) is debated.
- Patient age influences treatment decisions in endocrine surgery.
Purpose of the Study:
- To compare observation, molecular testing, and immediate thyroid surgery for indeterminate thyroid nodules.
- To evaluate the impact of patient age (50-90 years) on management strategy selection.
Main Methods:
- Decision analysis using a Markov model (TreeAgePro 2023).
- Sensitivity analyses (1-way and Monte Carlo probabilistic) were performed.
- Outcomes included quality-adjusted life-years and perioperative complications.
Main Results:
- Molecular testing demonstrated greater benefit than surgery or observation across all modeled ages.
- Observation became more beneficial than surgery at age 83.1 years.
- Clinical differences between the three management strategies were minimal.
Conclusions:
- Management of indeterminate thyroid nodules is complex.
- Clinically similar outcomes across strategies suggest individualized treatment.
- Shared physician-patient decision-making is crucial for optimal care.
