Evaluation and management of the solid thyroid nodule

A tremendous effort has been applied to the determination of optimum management strategies in patients with solid thyroid nodules. The systematic acquisition of experience with historical and physical examination features suggestive of malignancy and the careful crafting of noninvasive techniques to assist in this determination have each contributed to improvements in the safety and cost-effectiveness of management in these patients. Despite this progress, significant difficulties await resolution, including the preponderance of patients still subjected to thyroidectomy for benign follicular lesions and the reluctance of clinicians to abandon the use of diagnostic techniques that offer little useful information, such as routine scintillation scanning and diagnostic trials of suppressive therapy. An exciting area now in its infancy is the identification of useful molecular markers for the selection of the few malignant thyroid nodules from among the multitudes of benign lesions. As is true in diagnostic evaluation, uncertainty continues to be experienced by clinicians charged with proper nonsurgical management of the solid thyroid nodule. The use of thyroid hormone suppressive therapy, once considered a cornerstone of conservative management, has been cast in a new light revealing both the limited utility and potential harm associated with this approach. These uncertainties should not be viewed as impediments, but rather, as opportunities for growth, as it is controversy rather than complacency that stimulates new investigation and fresh approaches to old problems.