Clinical Skills Pearl Vol 2 (#15): Thyroid Nodules

Sent on behalf of Dr. M. Luterman

The American Association of Clinical Endocrinologists (AACE) released medical guidelines for the diagnosis and management of thyroid nodules. The new guidelines were developed by a panel of experts who encompassdifferent disciplines, including endocrinology, nuclear medicine.

The guidelines emphasize the importance of thyroid nodules in clinical practice. Thyroid nodules are common in the general population and they are typically discovered by palpation in 3% to 7% and by ultrasound (US) examination in 20% to 75%. "Extra" nodules are detected by ultrasound in up to 50% of patients with a single palpable thyroid
nodule.

The estimated annual incidence rate of 0.1% translates into approximately 300,000 new nodules that will be discovered in the U.S. this year. The overall frequency of malignancy in thyroid nodules is approximately 5%, requiring careful selection of patients for surgical treatment.

The panel agreed that all patients with palpable nodules should undergothyroid US examination and FNA. Ultrasound-guided FNA biopsy is suggested for a nodule yielding unsatisfactory aspirate on initial palpation-guided FNA; micronodules <1 cm; impalpable nodules; and for alcohol ablative therapy. The guidelines recommend that micronodules should be selected for biopsy primarily by history and ultrasound characteristics, rather than by size alone.

Click here for a link to the article (requires McMaster login).