Diagnostic Approach to Thyroid Nodules.

ABSTRACT

Derangement of thyroid function is a common clinical problem, with variable clinical presentations ranging from subtle, incidentally discovered disorders to overt disease, with frank disturbances of hormone levels and visible thyroid enlargement. In addition, there are the autoimmune thyroid disorders, and the neoplastic enlargements which result in palpable nodules. A large amount of new information has become available in recent times. They provide a comprehensive approach to diagnosis of thyroid nodules, ranging from initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, and their management. Recommendations regarding the initial management of thyroid cancer include those relating to optimal surgical management, radioiodine remnant ablation, and suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using ultrasound and serum thyroglobulin as well as those related to management of recurrent and metastatic disease. We went through the published literature available electronically and assessed the various studies and their results. The results were reviewed carefully and interpreted in order to analyse the approach to diagnosis of thyroid swellings, especially in the Indian context. Although a detailed review is outside the scope of this paper, we will attempt to discuss some of these guidelines, especially in light of the scenario in our region.