Evaluation of the thyroid nodule

SummaryThyroid nodules are the most common endocrine tumor, affecting over 50% of women over age 50. While the incidence of thyroid cancer is increasing, most thyroid nodules ultimately prove benign. An accurate, cost-effective algorithm for the evaluation of thyroid nodules includes clinical, biochemical, ultrasonographic and cytopathologic evaluation. The development of molecular diagnostics promises to transform the interpretation of previously indeterminate cytology results, but application of these techniques requires a thorough understanding of the impact of pre-test probability of malignancy on the performance of the molecular assays. Efforts to avoid diagnostic surgery in nodules that are cytologically indeterminate are admirable, but may be premature, pending additional confirmatory studies that prove this approach is safe. Meanwhile, the finding of oncogene mutations has sufficient specificity for cancer that this approach might be useful to tailor surgery. However, the cost effectiveness of this approach requires further evaluation.