Evaluation of the thyroid nodule.

BACKGROUND: Thyroid nodules are common, yet treatment modalities range from observation to surgical resection. Because thyroid nodules are frequently found incidentally during routine physical examination or imaging performed for another reason, physicians from a diverse range of specialties encounter thyroid nodules. Clinical decision making depends on proper evaluation of the thyroid nodule. METHODS: The current literature was reviewed and synthesized. RESULTS: Current evidence allows the formulation of recommendations and a general algorithm for evaluating the incidental thyroid nodule. CONCLUSIONS: Only a small percentage of thyroid nodules require surgical management. Diagnosis and treatment selection require a risk stratification by history, physical examination, and ancillary tests. Nodules causing airway compression or those at high risk for carcinoma should prompt evaluation for surgical treatment. In nodules larger than 1 cm, fine-needle aspiration biopsy is central to the evaluation as it is accurate, low risk, and cost effective. Subcentimeter nodules, often found incidentally on imaging obtained for another purpose, can usually be evaluated by ultrasonography. Other laboratory and imaging evaluations have specific and more limited roles. An algorithm for the evaluation of the thyroid nodule is presented.

[Goiter surgery from Kocher to today]. / Zur Strumachirurgie von Kocher bis heute.

When thyroid surgery was founded and developed by Billroth, Kocher, Miculicz, Halsted and De Quervain, a variable approach was used with respect to the extent of dorsal mobilization, completeness of goiter resection and finesse of the operative technique. These aspects of goiter resection are still of interest today: nodules are now considered as a growth marker and must be completely excised, necessitating careful dorsal mobilization; Kocher's correct plane of dissection is now anatomically defined as lying anterior to the lamella which covers the vessel and nerve-containing plate of the neck. In a prospective study, this technical approach for complete goiter excision has proven to harbour a low operative morbidity, to eliminate autonomous function, and to prevent goiter recurrence.