Thyroid nodule: A potentially malignant lesion; optimal management from a surgical perspective

SummaryThyroid nodules are very common lesions, frequently detected by modern imaging methods (mainly ultrasonography). Despite that most thyroid nodules represent benign lesions, a small but significant percentage of them are malignant. Surgery is indicated when there is underlying malignancy (or suspicion for), pressure symptoms, or for cosmetic reasons. Total/near total thyroidectomy is the most radical procedure, which achieves cure, avoids the possibility of reoperation in the future (completion thyroidectomy), and facilitates postoperative management of the patient with underlying malignancy. Simple observation and thyroid hormone suppressive therapy are acceptable management options for patients with presumably benign thyroid nodules. Radioiodine therapy may be used for the management of patients with hyperfunctioning (“hot”) thyroid nodules. Ablation of thyroid nodules (sclerosing therapy [alcohol injection] and laser photocoagulation) have been used for the in situ destruction of thyroid nodules; ablation therapy is currently viewed as experimental therapeutic method. Careful evaluation is required in order to avoid both overtreatment (mainly unnecessary surgery) as well as undertreatment of these potentially malignant, but highly curable lesions.