Thyroid nodules and goiters: Current standards of care

Malignancy must be ruled out in palpable as well as nonpalpable nodules larger than 1 cm. If the thyroid-stimulating hormone (TSH) level is normal or elevated, cytologic evaluation via fine-needle aspiration (FNA) is recommended if a nodule is identified. The use of ultrasound-guided FNA increases the diagnostic yield. About 5% to 10% of FNAs are nondiagnostic; this is more likely with smaller nodules and with palpation-guided FNA. Follow-up visits with benign nodules include clinical reassessement, TSH testing, and measurement of the nodule. Surgery is indicated for malignant nodules, large benign nodules, or symptomatic multinodular goiters. If the TSH level is subnormal, a radionuclide thyroid scan is recommended. Patients with "hot" nodules require evaluation and possible treatment for hyperthyroidism. Radioiodine therapy is safe and effective for these patients and for patients with toxic multinodular goiters (particularty those with small goiters and those with a history of thyroidectomy).