Nonsurgical Approaches to the Management of Thyroid Nodules

Sebastiano Filetti; Cosimo Durante; Massimo Torlontano


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

In This Article

Surveillance Alone

Once malignancy and abnormal thyroid function have been excluded, there is really no need to treat thyroid nodules unless they are already causing compression or cosmetic symptoms. Growth-preventing intervention seems excessive, in light of the limited growth rates documented in benign nodules so far. Clinical and sonographic evaluations should be carried out every 12–18 months, and when significant nodule growth is detected (i.e. a 20% increase in nodule diameter, as suggested by American Thyroid Association guidelines), FNA should be repeated.[16] If nodule size is stable, longer intervals between follow-up evaluations are recommended.[16] Rapid nodule growth and/or other clinical features suggestive of malignancy are indications for immediate surgery, even if the cytology report does not suggest malignancy.

Periodic follow-up alone is a valid option, particularly for small nonpalpable incidentalomas. It should be considered when the patient's thyroid function is normal, and the nodule is not causing compression or cosmetic problems.


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