The current assessment and management of thyroid nodules

Abstract

Introduction. The widespread use of diagnostic imaging favored the increasing incidence of thyroid nodules. Although most of nodules are benign, their clinical importance lies in the need to exclude malignancy. In assessing and managing thyroid nodules may occur the phenomenon of overdiagnosis and overtreatment on one hand and the risk of missing an aggressive thyroid cancer on the other hand. The equilibrium that has to be reached by health care providers. Materials and methods. We conducted a PubMed, MEDLINE, ISI Web of Science, Cochrane databases search for the relevant and recent guidelines, meta-analysis, randomized controlled trial, reviews articles related to „thyroid nodules assessment”, „thyroid nodules management”, „thyroid nodules guidelines”, „thyroid nodules surgery”. Results. The initial assessment of thyroid nodules includes an evaluation of clinical, laboratory and sonographic risk factors. Due to the sonographic features and size, the nodules are selected for biopsy. Cytologically benign nodules are usually followed-up, minimally invasive techniques may be required in certain cases. In suspected or confirmed malignancy, the treatment options of thyroid nodules include surgery or active surveillance. The main controversies appear in management of nodules with inconclusive cytology, low-risk cancers, multinodular goiters, hyperfunctioning nodules, and thyroid incidentalomas. Conclusions. Thyroid nodules due to the high incidence and heterogeneity of background diseases cannot be evaluated and managed in one standardized approach. In the existing literature, there are discussed multiple options for diagnosis and treatment of thyroid nodules. We have reviewed the guidelines recommendations, novel published data, and controversial questions for health care professionals, to understand and provide efficient, personalized, and cost-effective management of patients with thyroid nodules in order to avoid automatic intensive testing and intervention and balancing each case from the patient expectations and demands.