How are solitary thyroid nodules treated?

Updated: Oct 04, 2018
  • Author: Daniel J Kelley, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

Following a comprehensive medical history and thorough physical examination, fine-needle aspiration biopsy (FNAB) should be considered the initial step in the evaluation of the solitary thyroid nodule. Depending on the interpretation of the FNAB cytologic specimen, management consists of observation, levothyroxine suppression therapy, or surgery.

Patients with benign solitary thyroid nodules may undergo observation or levothyroxine suppression therapy as the initial treatment modality. Levothyroxine is typically administered for 6-12 months to determine if the solitary thyroid nodule decreases in size. If the nodule decreases in size after treatment with levothyroxine, this medication is discontinued, with follow-up examination of the thyroid nodule in 3-6 months. However, if a benign solitary thyroid nodule increases in size, a repeat trial of levothyroxine and repeat FNAB may be indicated. Additionally, growth of a thyroid nodule during levothyroxine therapy is a strong indication for surgery.

No consensus exists regarding the degree of thyroid suppression or the efficacy of levothyroxine therapy. In fact, many endocrinologists no longer recommend thyroid suppression because of potential long-term adverse effects, such as osteoporosis and cardiac arrhythmias. Still others maintain a thyroid-stimulating hormone (TSH) level ranging from 0.1-0.3 mU/L rather than suppressing to the lowest limits of detectability to avoid immediate toxicity and long-term side effects.

Solitary thyroid nodules that are malignant, suspicious, or indeterminate on FNAB require excisional biopsy in the form of thyroidectomy. Considerable controversy exists regarding the extent of surgery for malignant, suspicious, or indeterminate solitary thyroid nodules. However, principle philosophies involved in the arguments for either thyroid lobectomy or total thyroidectomy are beyond the scope of this article.


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