Preoperative evaluation of patients with thyroid nodules

Abstract

Introduction. Thyroid nodules are common entities that a found in 50% of population. Only a small percentage are considered to be malignant, but even if the majority of thyroid nodules are benign they harbor a malignant potential. The worldwide controversy about these entities is the therapeutic approach regarding which patients require surgical intervention. Aim of the study. To determine the indications for the surgical treatment of thyroid nodules Materials and methods. The study was performed on 82 patients with thyroid nodules selected for surgical treatment after a complex assessment. The age of the patients varied from 19 to 69years old. It was studied family history of thyroid disorders or cancer, results of anterior treatments, clinical signs. Patients were examined by serum tests (TSH, FT3, FT4, anti-TPO, anti-TG, calcitonin), ultrasound, Doppler ultrasound, sonoelastography, scintigraphy, fine needle aspiration-biopsy (FNAB) of thyroid gland, in addition to standard paraclinical investigations. Results. Indications for surgical treatment resulted from the correlation of following clinical and paraclinical data: nodules one centimeter or larger; nodules with rapid growth during several months or a year; nodules refractory to conservative treatment; nodules associated with globus sensation, dysphagia, pain in the anterior cervical region, cervical adenopathy; nodules with suspicious sonographic features – hypoecogenity, absence of peripheral halo, "taller than wide", intranodular vascularity, rigidity of tissues; scintigraphic cold nodules; cytologic suspicious or malignant nodules; increased levels of serum TSH and calcitonin, positive antithyroid antibodies; anamnesis of thyroid disease or cancer. Conclusions. The decision for surgical treatment of thyroid nodules must be taken on an interdisciplinary and individual basis after a clinical and paraclinical appropriate evaluation and according to a relevant guideline.