Thyroid nodules and the detection of thyroid cancer

Although thyroid nodules are common and cause concern about possible malignancy, relatively few are thyroid cancers, and relatively few thyroid cancers are lethal. These considerations justify a selective approach in recommending surgical excision of nodules. Selection of patients should be based on assessment of cancer risk factors in the history and physical examination, and most importantly on fine-needle aspiration biopsy of the thyroid with cytologic examination. Other testing in most cases should be limited to serum thyroid-stimulating hormone and antithyroid antibodies and a thyroid sonogram. With the results of this evaluation a recommendation can be made for either immediate surgery or observation. This approach should reduce the number of operations for benign thyroid nodules and avoid excessive diagnostic testing.