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Management implications from routine needle biopsy of hyperfunctioning thyroid nodules.

P G Walfish, H T Strawbridge, I B Rosen

    Surgery
    |December 1, 1985
    PubMed
    Summary
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    Routine fine-needle biopsy (FNB) for thyroid nodules without scintigraphy risks unnecessary surgeries for benign conditions. Thyroid function tests and scintigraphy are crucial before treatment to avoid complications like thyrotoxicosis.

    Area of Science:

    • Endocrinology
    • Surgical Pathology
    • Diagnostic Imaging

    Background:

    • Fine-needle biopsy (FNB) is a common diagnostic tool for thyroid nodules.
    • The utility of FNB without prior radioisotopic scintigraphy for hyperfunctioning nodules is debated.
    • Potential diagnostic and treatment consequences require careful evaluation.

    Purpose of the Study:

    • To assess the implications of performing routine FNB on all thyroid nodules without preceding scintigraphy.
    • To evaluate the diagnostic and therapeutic outcomes in patients with hyperfunctioning thyroid nodules undergoing FNB.

    Main Methods:

    • Retrospective analysis of 12 patients with documented hyperfunctioning thyroid nodules.
    • Evaluation of physical and cytologic findings from fine-needle aspiration biopsy (FNB).

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  • Assessment of concomitant lymphocytic thyroiditis and serum antithyroid antibody titers.

    • Main Results:

    • FNB on solid nodules raised suspicion for malignancy in 3/7 cases due to cellularity and pleomorphism.
    • Mixed (cystic and solid) nodules were often large, hemorrhagic, and recurrent.
    • Concomitant lymphocytic thyroiditis was present in 42% of patients, with 75% having positive antithyroid antibodies.

    Conclusions:

    • Sole reliance on FNB without scintigraphy may lead to unwarranted surgeries for benign hyperfunctioning adenomas.
    • Omitting scintigraphy can expose patients with thyrotoxicosis to surgical risks.
    • Thyroid function studies and scintigraphy are essential before surgery or hormone therapy to prevent iatrogenic hyperthyroidism.