Evidence-Based Evaluation of the Thyroid Nodule - 19/07/14

Doi : 10.1016/j.otc.2014.04.008

Louise Davies, MD, MS ^a,^b,^c,^⁎ , Gregory Randolph, MD ^d,^e
^a Department of Veterans Affairs Medical Center, VA Outcomes Group, 111B, 215 North Main Street, White River Junction, VT 05009, USA
^b Section of Otolaryngology, Geisel School of Medicine at Dartmouth, Rope Ferry Road, Hanover, NH 03755, USA
^c The Dartmouth Institute for Health Policy and Clinical Practice, 35 Centerra Parkway, Lebanon, NH 03766, USA
^d Division of Thyroid and Parathyroid Surgery, Department Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
^e Division of Surgical Oncology, Massachusetts General Hospital, 55 Fuit Street, Boston, MA 02114, USA

^∗Corresponding author. VA Outcomes Group, 111B, 215 North Main Street, White River Junction, VT 05009.

Résumé

This article reviews the most current literature on thyroid nodule evaluation, with particular attention to the problem of the incidentally identified thyroid nodule. Although traditional risk factors for thyroid cancer, such as age, gender, and familial syndromes, are still important, the manner in which a thyroid nodule comes to attention is of great importance these days when considering how to proceed in a workup. Most thyroid nodules today are discovered through radiologic imaging tests performed for other reasons. This article covers the key considerations that are vital in balancing the risks and benefits of thyroid nodule workup and treatment.

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Keywords : Thyroid, Thyroid nodule, Thyroid cancer, Evaluation, Thyroid neoplasm risk

Plan

Key points

The thyroid nodule—scope of the problem

Patient presentation

Assessment of risk factors

Age

Gender

Radiation Exposure

Family History and Cancer Syndromes

Workup of the thyroid nodule

TSH and Other Laboratory Tests

Closing thoughts about thyroid nodule evaluation

Risk of Death for the Patient Found to Have a Thyroid Cancer

Active Monitoring of Small Nodules

Limitations of Existing Guidelines on Thyroid Nodule Management

	Authorship: Conception and design, acquisition of data, analysis, drafting of article (L. Davies); conception and design, critical revision of article (G. Randolph).
	Disclaimers: The views expressed do not necessarily represent the views of the Department of Veterans Affairs, or the United States Government.
	Sources of Support: The Department of Veterans Affairs.
	Conflicts of Interest: No financial conflict of interest to declare.