Management of the thyroid nodule

Thyroid nodules are common, and a frequent reason for referral to secondary care. Clinical assessment and investigation should aim to address: functional status of the thyroid; exclusion of malignancy; and the presence of other symptoms (e.g. tracheal or oesophageal compression). A combination of neck ultrasound and fine-needle aspiration cytology (FNAC) can usually help establish a plan of management, allowing conservative management of most patients, and surgical treatment for those with suspected or confirmed thyroid cancer. The limitations of FNAC include a relatively high rate of inadequate/non-diagnostic samples, and the inability of cytology to distinguish between benign and malignant follicular neoplasms. Surgery may therefore be required to establish the diagnosis in patients with indeterminate nodules, in addition to its role in treatment for compressive symptoms or thyrotoxicosis.