Appropriate investigations are needed in patients presenting with thyroid nodules to determine the risk of malignancy and any need for surgical intervention. Most thyroid nodules are benign but require long-term follow up after the initial assessment.
- Thyroid nodules are very common and often asymptomatic.
- Nodules may require fine-needle aspiration (FNA) biopsy depending on their size and ultrasound characteristics.
- If the thyroid-stimulating hormone (TSH) level is low then a thyroid nuclear uptake scan is appropriate to assess for warm or hot nodule(s), which generally do not require FNA biopsy.
- The Bethesda system of thyroid FNA cytology results now reports six categories, each with different management implications.
- Thyroid malignancy is uncommon but surgery is sometimes required for diagnostic clarification and total thyroidectomy is required if malignancy is confirmed.