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Thyroid Nodule: Current Evaluation and Management

  • Alan A. Parsa
  • Hossein GharibEmail author
Chapter

Abstract

Thyroid nodules are common in clinical practice. The incidence of thyroid nodules has steadily increased over the past 50 years, primarily due to the widespread use of imaging modalities leading to detection of small, and often, incidental findings. With increased discovery of nodular disease, thyroid carcinoma prevalence has also increased significantly. These observations have prompted experts to develop a more efficient and cost-effective strategy to select nodules for biopsy, treatment, and follow-up.

Recent advances in thyroid nodule diagnosis and management include sonographic risk stratification of nodular appearance, application of ultrasound-guided fine needle aspiration, modified cytological classification, use of molecular markers in indeterminate cytology, minimally invasive procedures, and revised clinical practice guidelines. Ultrasound (US) findings and fine needle aspiration (FNA) results are essential in the optimal management of nodular thyroid disease.

Still, many questions remain, including what size nodule, or which US features, warrant biopsy? What is the role of molecular markers in the risk assessment of the indeterminate FNA cytology? How useful is the new cytological classification system? How should nodules be managed and followed? And, what is the utility of minimally invasive procedures, in comparison to conventional surgery, in treating thyroid nodules?

We have incorporated new recommendations and novel data in this chapter and hope that it will guide the reader to a better understanding of nodular thyroid disease and result in improved patient care.

Keywords

Thyroid nodule Bethesda cytological classification Ultrasound (US) Molecular markers Multinodular goiter (MNG) Fine needle aspiration (FNA) biopsy Thyroid stimulating hormone (TSH) Thyroxine (T4) 

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© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Medicine, John A. Burns School of Medicine, University of HawaiiHonoluluUSA
  2. 2.Division of Endocrinology, Diabetes, Metabolism and NutritionMayo Clinic College of MedicineRochesterUSA

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