Age, Not Frailty, Is Associated With Thyroidectomy of Indeterminate Thyroid Nodules

The management of indeterminate thyroid nodules has become increasingly complex. We examined predictors of surgical intervention for indeterminate thyroid nodules, particularly the role of age and frailty on proceeding with thyroidectomy.

A single-institution retrospective study was conducted of adult patients who underwent thyroid nodule fine needle aspiration between 2010 and 2022 with Bethesda III and IV cytology. Patient demographics, clinical history, nodule characteristics, molecular testing information, and use of thyroidectomy were reviewed. A modified frailty index score was calculated for each patient. Logistic regression was used to identify predictors for thyroidectomy.

A total of 377 patients with 402 indeterminate thyroid nodules were included. Of these, 222 nodules (55.2%) were Bethesda IV and 231 (57.4%) underwent thyroidectomy. Patients who underwent thyroidectomy were younger, had a larger nodule size, were more likely to have Bethesda IV cytology, and more likely to have a mutation found on molecular testing if performed (P < 0.05). There was no significant difference in modified frailty index score between the two cohorts. On multivariate analysis, Bethesda IV cytology (odds ratio [OR] 2.1, P = 0.001) and the presence of a mutation on molecular testing (OR 3.9, P = 0.003) were independently associated with increased likelihood of thyroidectomy. Older age (OR 0.98, P = 0.017) and performing molecular testing (OR 0.16, P = 0.038) were associated with decreased likelihood of thyroidectomy. Frailty was not associated with likelihood of thyroidectomy.

Older age, rather than the presence of reported medical comorbidities, was associated with surveillance of indeterminate thyroid nodules. Long-term outcomes of surveillance in older adult patients with indeterminate thyroid nodules require further investigation.