Diagnosis and management of thyroid nodule

To review the current medical evidence in the diagnosis and management of thyroid nodules.

The widespread use of imaging modalities in recent years has led to frequent discovery of incidental thyroid nodules. These nodules are mostly benign (over 90%), hence precise insight in evaluating nodules of concern and following up other nodules is important to avoid unnecessary surgeries and its complications.

Certain nodules, which are symptomatic or suspicious on clinical evaluation, need further evaluation with ultrasonography and cytopathology before embarking on definitive treatment. Indeterminate nodules can further be analysed by newer advances like molecular tests, liquid biopsy to guide further management. Active surveillance is an option for select malignant nodules that fit the defined criteria. Small benign nodules which are symptomatic or of cosmetic concern can also be treated with minimally invasive options of ethanol injection or thermal ablative techniques. Hemithyroidectomy is diagnostic for follicular neoplasm or definitive treatment for solitary, symptomatic or hypersecreting benign nodules or even for small solitary thyroid carcinoma. Total thyroidectomy is option of choice for symptomatic or hypersecreting or malignant multiple nodules.