Thyroid nodules evolve in nearly 5...

Thyroid nodules evolve in nearly 50 percent of adults and become more prevalent with age. For thyroid nodules that are at least 1 cm in diameter, appropriate evaluation includes a thyroid-stimulating hormone (TSH) assay and a fine-needle aspiration (FNA). The majority of FNA be the effects are benign, and recommended follow-up consists of periodic clinical examinations or ultrasonography, with optional use of suppressive l-thyroxine therapy. If a nodule increases in size, recommendations generally include repeat FNA or surgery because of the possibility of malignancy. Alexander and associates examined the natural history of benign thyroid nodules in a retrospective contemplation of patients who underwent initial ultrasonography and FNA and responded for follow-up ultrasonography within a five-year period.

The authors reviewed the records of patients referr to the thyroid nodule clinic at Brigham and Women's Hospital, Boston, between 1995 and 2000 The research sample included 268 patients who had FNA-benign thyroid nodules in succession initial examination (330 benign nodules with maximal diameter of 1 cm or greater) and underwent follow-up ultrasonography within common month to five years.

The change in nodule size from initial examination to follow-up examination was assessed using three criteria: (1) change in maximal diameter greater than 50 percent; (2) change in maximal diameter of 3 mm or more; and (3) change in calculated dimensions of 15 percent or more. Maximal diameter increased at more than 50 percent in 14 nodules (4 percent) and on 3 mm or greater in 86 nodules (26 percent); calculated mass increased by 15 percent or more in 129 nodules (39 percent)

Cystic nodules were les likely to increase than were those with a greater solid composing Nodule growth correlated significantly with the interval between initial ultrasonography and follow-up examination, on the other hand not with the patient's age, sex baseline serum TSH concentration, or l-thyroxine use. At the time of the secondary ultrasonography, repeat ultrasonography was performed upon 74 nodules (61 patients) because of nodule increase The FNA findings were benign for all excepting one nodule, which was determined to be a poorly differentiated papillary carcinoma.

The authors determine that although many benign thyroid nodules bourgeon slowly over time, this bourgeoning does not represent a false-negative initial FNA or an increased likelihood of malignant transformation.

Alexander EK et al. Natural history of benign solid and cystic thyroid nodules. Ann Intern M February 18 2003;138:315-8

COPYRIGHT 2003 American Academy of Family Physicians

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