Does thyroid nodules need surgery?

Thyroid nodules are palpable in about 5% of adults , but their prevalence varies greatly worldwide
.

In view of this high prevalence, doctors usually find it by physical examination or accidentally discover it when performing imaging examinations for other purposes (such as carotid ultrasound, cervical MRI)

Thyroid nodules are palpable in about 5% of adults , but their prevalence varies greatly worldwide

The occurrence of nodules is more common in iodine-deficient areas, women and the elderly

The diagnosis of isolated nodules is shown in Figure 1

Table 1 Treatment process for patients with thyroid nodules

Table 1 Treatment process for patients with thyroid nodules

FNA, fine needle aspiration biopsy; LN, lymph node; PTC, papillary thyroid carcinoma;

FNA, fine needle aspiration biopsy; LN, lymph node; PTC, papillary thyroid carcinoma;

TSH, thyroid stimulating hormone; US, ultrasound

TSH, thyroid stimulating hormone; US, ultrasound

The guidelines from the American Thyroid Association and the American Association of Clinical Internal Medicine with the background of evidence-based medicine recommend FNA for nodules based on the cut-off value of ultrasound image characteristics and size, and the cut-off value of nodule size with more suspicious ultrasound characteristics Lower
.

Ideally under ultrasound guidance, when a skilled physician completes the operation and an experienced cytopathologist assists in reading the film, FNA biopsy has good sensitivity and specificity

The guidelines from the American Thyroid Association and the American Association of Clinical Physicians with the background of evidence-based medicine all recommend FNA of nodules based on the cut-off value of ultrasound image characteristics and size, and the cut-off value of nodule size with more suspicious ultrasound characteristics Lower

In some large-scale studies, the results of FNA biopsy showed that : 65% were benign, 5% were malignant or suspiciously malignant, 10% could not be diagnosed or insufficient sampling was difficult to diagnose, and 20% were uncertain

Cytology results showed that malignant patients should undergo surgery, and preoperative ultrasound assessment of cervical lymph nodes

The three new cytological classifications in the TBS classification are associated with different risks of malignancy (Table 2 )

Malignant risk

Undiagnosed or unsatisfied

1%～5%

benign

2%～4%

Atypical or indeterminate follicular lesions ( AUS/FLUS )

15%～20%

Follicular neoplasm

20%～30%

Suspiciously malignant

60%～75%

Malignant

97%～100%

Diagnostic classification

Malignant risk

Undiagnosed or unsatisfied

1%～5%

benign

2%～4%

Atypical or indeterminate follicular lesions ( AUS/FLUS )

15%～20%

Follicular neoplasm

20%～30%

Suspiciously malignant

60%～75%

Malignant

97%～100%

Diagnostic classification

Malignant risk

Diagnostic classification

Diagnostic classification

Diagnostic classification

Malignant risk

Malignant risk

Malignant risk

Undiagnosed or unsatisfied

1%～5%

Undiagnosed or unsatisfied

Undiagnosed or unsatisfied

Undiagnosed or unsatisfied

1%～5%

1%～5%

1%～5%

benign

2%～4%

benign

benign

benign

2%～4%

2%～4%

2%～4%

Atypical or indeterminate follicular lesions ( AUS/FLUS )

15%～20%

Atypical or indeterminate follicular lesions ( AUS/FLUS )

Atypical or indeterminate follicular lesions ( AUS/FLUS )

Atypical or indeterminate follicular lesions ( AUS/FLUS )

15%～20%

15%～20%

15%～20%

Follicular neoplasm

20%～30%

Follicular neoplasm

Follicular neoplasm

Follicular neoplasm

20%～30%

20%～30%

20%～30%

Suspiciously malignant

60%～75%

Suspiciously malignant

Suspiciously malignant

Suspiciously malignant

60%～75%

60%～75%

60%～75%

Malignant

97%～100%

Malignant

Malignant

Malignant

97%～100%

97%～100%

97%～100%

Table 2 BETHESDA classification of thyroid cytology

Table 2 BETHESDA classification of thyroid cytology

   In addition, most AUS/FLUS nodules and follicular neoplasms are cytologically benign ; only 10%-30% are malignant
.

The traditional approach for these patients is to diagnose lobectomy for histopathological diagnosis

   In addition, most AUS/FLUS nodules and follicular neoplasms are cytologically benign ; only 10%-30% are malignant

   Evaluating thyroid nodules is stressful for most patients

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