Approach to Solitary Thyroid Nodule

The solitary thyroid nodule, defined as a palpably discrete swelling within an otherwise apparently normal gland, is usually a benign lesion. Fifty per cent of patients thought on basis of physical examination to have a sol, itary nodule have multiple nodules when studied by ultrasonography. Even in patients with palpable solitary thyroid nodules who are undergoing clinical evaluation, the overall risk that the nodule is cancerous is less than 5%. Thyroid nodules identified as an incidental finding during ultrasonography, magnetic resonance imaging. or computed tomography do not require further evaluation unless they are palpable, greater than 1 cm in size, or both.Detail evaluation of thyroid nodules includes physical examination, Biochemical test, Ultrasonography, Thyroid scanning and fine needle aspiration biopsy. Fine needle aspiration biopsy (FNAB) is presently considered to be the most cost effective initial method. It discriminates the malignant nodules from benign and suspicious or indeterminate nodules. For suspicious or indeterminate nodules on repeat FNAB, thyroid scanning is done. Hot nodules are treated for hyperthyroidism and do no need further evaluation since hyperfunctioning nodules are usually benign. TSH is an important assay done to detect underlying hyper or hypothyroidism. Malignant nodules are managed surgically with total or near total thyroidectomy followed by Radioiodine ablation. Benign nodules can be given a trial of levothyroxine suppressive therapy followed by yearly follow up with repeat FNAB or early if symptoms develop.