Nonsurgical Approaches to the Management of Thyroid Nodules

Sebastiano Filetti; Cosimo Durante; Massimo Torlontano

Disclosures

Nat Clin Pract Endocrinol Metab. 2006;2(7):384-394. 

In This Article

Conclusions and Perspectives

The increasingly frequent detection of nonpalpable thyroid nodules in asymptomatic patients requires new approaches for their management. FNA cytology is the most sensitive and specific method for identifying suspicious or malignant nodules that require surgical treatment. The vast majority of thyroid nodules are benign. The current lack of consensus surrounding the optimal management of benign thyroid nodules is largely the result of our incomplete knowledge of the natural history of these nodules and of the long-term results of nonsurgical treatment approaches; hence, currently available data are not sufficient to allow us to draw any solid conclusions.

If the objective of treatment is the control of nodule growth, periodic clinical and morphological surveillance seem to be sufficient for the vast majority of benign nodules, which are asymptomatic, nontoxic, and slow-growing. If surgery is not indicated, simple surveillance is the best option. Although volume reduction can be achieved with levothyroxine-induced suppression of TSH in certain nodules, the markers of responsiveness have yet to be defined. Routine TSH-suppressive therapy should not, therefore, be recommended for benign thyroid nodules. When surgery is contraindicated, for large, nontoxic or toxic goiters, RAI is the treatment of choice. PEI is mainly indicated for ablation of cystic (or predominantly cystic) thyroid lesions. PLA is still an experimental procedure, and is indicated primarily for relief of local neck discomfort when surgery is contraindicated. In all cases, decisions on the management of benign thyroid nodules should always be based on a careful analysis of benefits and risks to the patient.


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