[Which thyroid nodules need to be operated? (author's transl)]

Area of Science:

• Endocrinology
• Oncology
• Nuclear Medicine

Background:

• Thyroid nodules are common, with up to 20% of cold nodules being malignant.
• Cystic nodules measuring 1-4 cm have a low malignancy rate (1%), often not requiring surgery.
• Hot nodules present a negligible cancer risk but can lead to thyrotoxicosis.

Purpose of the Study:

• To outline diagnostic and management strategies for thyroid nodules.
• To differentiate between benign and malignant nodules based on clinical and imaging findings.
• To guide treatment decisions for hot nodules and prevent thyrotoxicosis complications.

Main Methods:

• Comprehensive evaluation including clinical examination, scintigraphy, and thyroid echotomography.
• Assessment of tracheal X-ray, serum antithyroid antibodies, and thyroid function tests.
• Consideration of trial therapy with thyroid hormones in select cases.

Main Results:

• Surgery is generally not indicated for entirely cystic nodules (1-4 cm) due to low malignancy rates.
• Hot nodules, while rarely cancerous, necessitate treatment (surgery or 131I) to manage thyrotoxicosis, especially in elderly or cardiac patients.
• A thorough diagnostic workup is crucial for appropriate nodule management.

Conclusions:

• Diagnostic imaging and clinical assessment are key to determining the malignancy risk of thyroid nodules.
• Treatment for hot nodules should prioritize preventing thyrotoxicosis, with therapeutic choices tailored to individual patient profiles.
• Judicious management of thyroid nodules balances the need for cancer detection with the avoidance of unnecessary interventions.