Is Surgery the Treatment of Choice for Every Thyroid Nodule?

  • Semra Günay
  • Orhan Yalçın


The correct diagnosis of the thyroid nodule begins with clinical examination, interrogation, biochemical detection of the hormone level and ultrasonography (USG), and, if necessary, fine needle aspiration cytology (FNAC). The FNAC decision is based on the clinical and radiological (USG) characteristics of the nodule. At this stage, it is essential to classify the nodule according to current knowledge and guidelines regarding the risk of cancer. Thyroid nodule diagnosis is prevalent, but no surgical treatment is needed to treat all of them.

A 29-year-old male patient with a diagnosis of papillary microcarcinoma who underwent surgical resection for a solid thyroid nodule was presented. While describing the clinical process of this case, the limits of surgery (total thyroidectomy–hemithyroidectomy) were discussed.

The correct implementation of procedures for the operation decision, the evaluation of the results, and the place of concept of work multidisciplinary in the whole process were reviewed according to current guidelines.


Thyroid nodule Ultrasonography FNA Risk stratification Thyroid cancer risk Thyroidectomy Hemithyroidectomy 


  1. 1.
    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid Cancer. Thyroid. 2016;26:1–133. Scholar
  2. 2.
    Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab. 2009;94:1748–51. Scholar
  3. 3.
    Gharib H, Papini E, Paschke R, Duick DS, Harrell RM, Hegedüs L, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules – 2016 update. Endocr Pract. 2016;22:622–39. Scholar
  4. 4.
    Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology. 2011;260:892–9. Scholar
  5. 5.
    Xie C, Cox P, Taylor N, LaPorte S. Ultrasonography of thyroid nodules: a pictorial review. Insights imaging. 2016;7(1):77–86. Scholar
  6. 6.
    Varshney R, Forest VI, Mascarella MA, et al. The Mcgill thyroid nodule score - does it help with indeterminate thyroid nodules. J Otolaryngol Head Neck Surg. 2015;44:2. Scholar
  7. 7.
    Renuka V, Saila Bala G, Aparna C, Kumari R, Sumalatha K. The Bethesda system for reporting thyroid cytopathology: interpretation and guidelines in surgical treatment. Indian J Otolaryngol Head Neck Surg. 2012;64:305–11. Scholar
  8. 8.
    Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol. 2009;132:658–65. Scholar
  9. 9.
    Leboulleux S, Tuttle RM, Pacini F, Schlumberger M. Papillary thyroid microcarcinoma: time to shift from surgery to active surveillance? Lancet Diabetes Endocrinol. 2016;4:933–42. Epub 2016 Aug 20.CrossRefPubMedGoogle Scholar
  10. 10.
    Nickel B, Brito JP, Barratt A, Jordan S, Moynihan R, McCaffery K. Clinicians views on management and terminology for papillary thyroid microcarcinoma: a qualitative study. Thyroid. 2017;27(5):661–71. Scholar
  11. 11.
    Vuong HG, Duong UN, Altibi AM, Ngo HT, Pham TQ, Tran HM, et al. A meta-analysis of prognostic roles of molecular markers in papillary thyroid carcinoma. Endocr Connect. 2017;6:R8–R17. Epub 2017 Feb 20. Review.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Semra Günay
    • 1
  • Orhan Yalçın
    • 1
  1. 1.University of Health Sciences (SBÜ), Okmeydanı Training and Research Hospital, Division of Breast and Endocrin Surgery, OkmeydanıIstanbulTurkey

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