Thyroid nodules are being increasingly detected, and most thyroid cancers in Australia are now diagnosed by ultrasound before they become clinically apparent as palpable nodules. Management is individualised and dynamic, involving identifying and accurately risk stratifying malignant nodules so the most appropriate treatment is selected for each patient.
- Thyroid nodules should be carefully assessed for suspicious ultrasound features and these in addition to nodule size and growth rate determine the need for biopsy.
- Most thyroid cancers in Australia are now diagnosed by ultrasound before they become clinically apparent as a palpable nodule.
- The management approach is individualised; the goal is to identify and accurately risk stratify malignant nodules to select the most appropriate treatment for each patient, avoiding over-investigating and over-treating.
- The American Thyroid Association 2015 evidence-based guidelines for the management of thyroid nodules and thyroid malignancy (which are generally followed in Australia) provide an individualised management plan rather than a ‘one size fits all’ approach. Ongoing management at all stages involves dynamic risk assessment.
- Post-thyroidectomy thyroid-stimulating hormone levels are kept suppressed below the normal range in high-risk patients but in other patients are kept in the low normal range.
- Serum thyroglobulin measurement has minimal use in patients with an intact thyroid but is important in thyroid cancer follow up.
Picture credit: © DNA Illustrations, Inc. Thyroid cancer.