Surgical Indication in Thyroid Nodules ≥4 cm: Do Larger Nodules Carry Higher Malignancy and Complication Risks?

The management of thyroid nodules is outlined in various clinical guidelines. While the American Thyroid Association guideline provides more systematic algorithms for thyroid nodules smaller than 4 cm in diameter, there is no consensus on the management of nodules ≥4 cm. This study aims to contribute to this topic by evaluating the clinical data of patients who underwent thyroidectomy for nodules measuring ≥4 cm.

This study included 199 patients who underwent thyroidectomy due to thyroid nodules measuring ≥4 cm in diameter. Patients were evaluated based on age, sex, preoperative, postoperative day 1, and at least 1-month postoperative calcium (Ca) and parathyroid hormone (PTH) levels, maximum nodule diameter, fine-needle aspiration biopsy (FNAB) status, and final pathology data.

A total of 199 patients (28 men, 171 women; mean age: 46.52±13.82 y) were included in the study. Malignancy was identified in 17.6% of the cases. Nodule size was significantly larger in male patients (P=0.017) and in malignant lesions, particularly those ≥4 cm. FNAB was performed in 39.2% of the patients; there was no statistically significant association between FNAB performance and age group, sex, or pathology results. However, false-negative FNAB results were detected in 25% of malignant cases, indicating the limited sensitivity of FNAB, especially in nodules ≥4 cm.

Thyroid nodules measuring ≥4 cm may warrant surgical intervention regardless of whether FNAB was performed or reported as benign, due to their relatively higher rates of malignancy and associated complications.