Evaluation and Management of the Euthyroid Nodular and Diffuse Goiter

  • Peter A. Singer
Part of the Contemporary Endocrinology book series (COE, volume 2)


Palpable thyroid nodules among adult individuals living in the United States are very common, with a prevalence of approx 4–7% (1). By contrast, the prevalence of nodules incidentally detected at autopsy, or by the use of high resolution ultrasonography, has ranged from approx 20 to 65% in individuals without a prior history of thyroid disease (26). Thyroid nodules are more common in women, estimates varying from a female-to-male ratio of 1.2:1 (2,7) to 4.3:1 (8) and increase in prevalence with advancing age (9,10). The likelihood of a single palpable thyroid nodule being malignant is less than 10%, and possibly closer to 5% (1,10,11). Nevertheless, because of the possibility of cancer, some clinicians, especially those in the surgical subspecialties, recommend that all nodules be removed. Other physicians, especially endocrinologists, recommend a more conservative approach in order to avoid unnecessary surgery. Thus, there is an ongoing debate regarding the appropriate evaluation and management of individuals with thyroid nodules. The main purpose of this article is to address these issues and to provide a clinically applicable and cost-effective approach to the evaluation and management of nodular thyroid disease. There are several excellent reviews to which the reader is directed (1,9,10,12–15).


Thyroid Cancer Thyroid Nodule Papillary Thyroid Cancer Medullary Thyroid Cancer Multinodular Goiter 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  • Peter A. Singer

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