Southwestern internal medicine conference: Management of thyroid nodules

This review describes the frequency of solitary thyroid nodules and their relationship to thyroid cancer. The importance of selecting patients appropriately for surgical excision is stressed. The factors predisposing to nodule formation and to a nodule being malignant are reviewed with emphasis that prior radiation exposure does not appear to increase the likelihood that a given nodule harbors a malignancy. In considering the laboratory evaluation of thyroid nodules, the limitations of isotope scans and ultrasonography are noted. Fine needle aspiration biopsy is described as revolutionizing the management of thyroid nodules and decreasing unnecessary operations. In the context of the natural history of differentiated thyroid cancer, the application of a decision analysis model to management options is described in some detail, and a cost-effective management regimen is recommended with fine needle aspiration biopsy as the initial procedure.