Surgical Oncology
Volume 15, Issue 1 , Pages 43-55 , July 2006

Thyroid nodules: Does the suspicion for malignancy really justify the increased thyroidectomy rates?

  • George H. Sakorafas

      Affiliations

    • Fourth Department of Surgery, Athens University, Medical School, Attikon University Hospital, Athens, Greece
    • Corresponding Author InformationCorresponding author. Address: Arkadias 19-21, Athens, GR-11526, Greece. Tel.: +302107487318; fax: +302107487192.
    • ,
  • George Peros

      Affiliations

    • Fourth Department of Surgery, Athens University, Medical School, Attikon University Hospital, Athens, Greece
    • ,
  • David R. Farley

      Affiliations

    • Mayo Clinic College of Medicine, Rochester, MN, USA

References 

  1. Hegedus L. The thyroid nodule. New England Journal of Medicine. 2004;351:1764–1771
  2. Mazzaferri EL. Management of solitary thyroid nodule. New England Journal of Medicine. 1993;328:553–559
  3. Tyler DS. Evaluation of solitary thyroid nodules. Annals of Surgical Oncology. 2000;7:376–398
  4. Singer PA, Cooper DS, Daniels GH, et al. Treatment guidelines for patients with thyroid nodules and well-differentiated thyroid cancer. Archives of Internal Medicine. 1996;156:2165–2172
  5. Nakhjavani M, Esteghamati AR, Khalapfour M. A study of 558 cases of cold thyroid nodules, 1991–1999; comparison to a decade earlier. International Journal of Endocrinology and Metabolism. 2004;2:82–86
  6. Bursh HB. Evaluation and management of the solid thyroid nodule. Surgical Clinics of North America. 1995;24:663–710
  7. Feld S. AACE clinical practice guidelines for the diagnosis and management of thyroid nodules. Endocrine Practice. 1996;2:78–84
  8. Tan GH, Gharib H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Annals of Internal Medicine. 1997;126:226–231
  9. Rallison ML, Dobyns MB, Keating FR, et al. Thyroid nodularity in children. Journal of the American Medical Association. 1975;233:1069–1072
  10. Trowbridge EL, Matovinovic J, McLaren GD, et al. Iodine and goiter in children. Pediatrics. 1975;56:82–90
  11. Mortensen JD, Woolner LB, Bennett WA. Gross and microscopic findings in clinically normal thyroid glands. Journal of Clinical Endocrinology and Metabolism. 1955;15:1270–1280
  12. Bruneton JN, Balu-Maestro C, Marcy PY, et al. Very high frequency (13MHz) ultrasonographic examination of the normal neck; detection of normal lymph nodes and thyroid nodules. Journal of Ultrasound in Medicine. 1994;13:87–89
  13. Tomimori E, Pedrinola F, Cavaliere H, et al. Prevalence of incidental thyroid disease in a relatively low iodine intake area. Thyroid. 1995;5:273–276
  14. Pearce EN, Braverman LE. Papillary thyroid microcarcinoma; outcomes and implications for treatment. Journal of Clinical Endocrinology and Metabolism. 2004;89:3710–3712
  15. Vander JB, Gaston EA, Dawber TR. The significance of nontoxic nodules: final report of a 15-year study of the incidence of thyroid malignancy. Annals of Internal Medicine. 1968;69:537–540
  16. Hermanson L, Gargill SL, Lesses MF. The treatment of nodular goiter. Journal of Clinical Endocrinology. 1952;12:112–129
  17. Furmanchuk AW, Roussak N, Ruchti C. Occult thyroid carcinomas in the region of Minsk, Belarus. An autopsy study of 215 patients. Histopathology. 1993;23:319–325
  18. Hellwig CA. The thyroid gland in Kansas. American Journal of Clinical Pathology. 1935;5:103–111
  19. Rice CO. Incidence of nodules in the thyroid. A comparative study of symptomless thyroid glands removed at autopsy and hyperfunctioning goiters operatively removed. Archives of Surgery. 1932;24:505–515
  20. Hegedus L, Bonnema SJ, Bennedbaek FN. Management of simple nodular goiter: current status and future perspectives. Endocrine Reviews. 2003;24:102–132
  21. Komorowski RA, Hanson GA. Occult thyroid pathology in the young adult: an autopsy study of 138 patients without clinical thyroid disease. Human Pathology. 1988;19:689–696
  22. Kang HW, No JH, Chung JH, et al. Prevalence, clinical, and ultrasonographic characteristics of thyroid incidentalomas. Thyroid. 2004;14:29–33
  23. Knudsen N, Bulow I, Jorgensen T, et al. Goitre precalence and thyroid abnormalities at ultrasonography: a comparative epidemiological study in two regions with slightly different iodine status. Clinical Endocrinology. 2000;53:479–485
  24. Price R, Horvath K, Moore FD. Surgery for solitary thyroid nodules: assessment of methods to select patients at low risk for unsuspected malignancy in the unaffected lobe and the possible utility of preoperative thyroid ultrasound. Thyroid. 1993;3:87–92
  25. Witterick IJ, Abel SM, Hartwick W, et al. Incidence and types of nonpalpable thyroid nodules in thyroid removed for palpable disease. Journal of Otolaryngology. 1993;22:294–300
  26. Wong CK, Wheeler MH. Thyroid nodules: rational management. World Journal of Surgery. 2000;24:934–941
  27. Brander AEE, Viikinkoski VP, Nickels JI, Kivisaari LM. Importane of thyroid abnormalities detected at US screening: a 5-year follow-up. Radiology. 2000;215:801–806
  28. Kuma K, Matsusuka F, Yokozawa T, et al. Fate of untreated benign thyroid nodules: results of long-term follow-up. World Journal of Surgery. 1994;18:495–498
  29. Grant CS, Hay ID, Cough IR, et al. Long-term follow-up of patients with benign thyroid fine-needle aspiration cytologic diagnoses. Surgery. 1989;106:980–986
  30. Gagel RF, Goepfert H, Callender DL. Changing concepts in the pathogenesis and management of thyroid carcinoma. CA: A Cancer Journal for Clinicians. 1996;46:261–283
  31. Deaconson TF, Wilson SD, Cerletty JM, Komorowski RA. Total or near total thyroidectomy versus limited resection for radiation-association thyroid nodules: a twelve-year follow-up of patients in a thyroid screening program. Surgery. 1986;100:1116–1120
  32. Soh EY, Clark OH. Surgical considerations and approach to thyroid cancer. Surgical Clinics of North America. 1996;25:115–139
  33. Witt TR, Meng RL, Economou SG, et al. The approach to the irradiated thyroid. Surgical Clinics of North America. 1979;59:45–64
  34. Schneider AB. Radiation-induced thyroid tumors. Endocrinology and Metabolism Clinics of North America. 1990;19:495–509
  35. DeGroot LJ. Diagnostic approach and management of patients exposed to irradiation to the thyroid. Journal of Clinical Endocrinology and Metabolism. 1989;69:925–928
  36. Schneider AB, Ron E, Lubin J, et al. Dose–response relationships for radiation-induced thyroid cancer and thyroid nodules: Evidence for the prolonged effects of radiation on the thyroid. Journal of Clinical Endocrinology and Metabolism. 1993;77:362–369
  37. Schneider AB, Recant W, Pinsky SM, et al. Radiation-induced thyroid carcinoma: clinical course and results of therapy in 296 patients. Annuals of Internal Medicine. 1986;105:405–412
  38. Schottenfeld D, Gershman ST. Epidemiology of thyroid cancer. Cancer. 1978;28:66–71
  39. Bentley AA, Gillespie C, Malis D. Evaluation and management of a solitary thyroid nodule in a child. Otolaryngology Clinics of North America. 2003;36:117–128
  40. McCaffrey TV. Evaluation of the thyroid nodule. Cancer Control. 2000;7:223–228
  41. Schlumberger MJ. Papillary and follicular thyroid carcinoma. New England Journal of Medicine. 1998;338:297–306
  42. Skinner MA, Moley JA, Dilley WG, et al. Prophylactic thyroidectomy in multiple endocrine neoplasia type 2A. New England Journal of Medicine. 2005;353:1105–1113
  43. Hyer SL, Newbold K, Harmer C. Familial medullary thyroid cancer: clinical aspects and prognosis. European Journal of Surgical Oncology. 2005;31:415–419
  44. Perrier ND, van Heerden JA, Goellner JR, et al. Thyroid cancer in patients with familial adenomatous polyposis. World Journal of Surgery. 1998;22:738–742
  45. Hizawa K, Iida M, Aoyagi K, et al. Thyroid neoplasia and familial adenomatous polyposis/Gardner's syndrome. Journal of Gastroenterology. 1997;32:196–199
  46. Hemmings CT. Thyroid pathology in four patients with Cowden's disease. Pathology. 2003;35:311–314
  47. Alsanea O, Clark OH. Familial thyroid cancer. Current Opinions in Oncology. 2001;13:44–51
  48. Thieblemont C, Mayer A, Dumontet C, et al. Primary thyroid lymphoma is a heterogenous disease. Journal of Clinical Endocrinology and Metabolism. 2002;87:105–111
  49. Di Cataldo A, Sgrpo AV, Occhipinti R, et al. Rare primary tumors of the thyroid. Journal de chirurgie. 2004;25:420–423
  50. Chao TC, Lin JD, Chen MF. Surgical treatment of thyroid cancers associated with concurrent Graves disease. Annals of Surgical Oncology. 2004;11:407–412
  51. Mazzaferri EL. Thyroid cancer in thyroid nodules. American Journal of Medicine. 1992;93:359–362
  52. Alexander EK, Hurwitz S, Heering JP, et al. Natural history of benign solid and cystic thyroid nodules. Annals of Internal Medicine. 2003;138:315–318
  53. Daniels GH. Thyroid nodules and nodular thyroids: a clinical overview. Comprehensive Therapy. 1996;22:239–250
  54. Kuma K, Matsuzuka F, Kobayashi A, et al. Outcome of long standing solitary thyroid nodules. World Journal of Surgery. 1992;16:583–588
  55. Massie JD, Austin HM, Tarcan Y. Rapid thyroid enlargement: intracystic hemorrhage. Clinical Nuclear Medicine. 1981;6:583
  56. Tagliaferro P, Talamo C, Chini L, Mangiola A. Massive intra-thyroid hemorrhage in a patient with adenoma. Minerva Medica. 1980;71:1693–1700
  57. Lawrence W, Kaplan BJ. Diagnosis and management of patients with thyroid nodules. Journal of Surgical Oncology. 2002;80:157–170
  58. Tan GH, Gharib H, Reading CC. Solitary thyroid nodule. Comparison between palpation and ultrasonography. Archives of Internal Medicine. 1995;155:2418–2423
  59. Brander A, Viikinkoski P, Tuuhea J, et al. Clinical versus ultrasound examination of the thyroid gland in common clinical practice. Journal of Clinical Ultrasound. 1992;20:37–42
  60. Christensen SB, Tibblin S. The reliability of the clinical examination of the thyroid gland. A prospective study of 100 consecutive patients surgically treated for hyperparathyroidism.. Annals of Chirurgiae et Gynaecologiae. 1985;74:151–154
  61. Siminoski K. Does this patient have a goiter?. Journal of American Medical Association. 1995;273:813–817
  62. Bennedbaek FN, Perrild H, Hegedus L. Diagnosis and treatment of the solitary thyroid nodule: results of a European survey. Clinical Endocrinology (Oxford). 1999;50:357–363
  63. Bennedbaek FN, Hegedus L. Management of the solitary thyroid nodule: results of a North American survey. Journal of Clinical Endocrinology. 2000;85:2493–2498
  64. Jarlov AE, Hegedus L, Gjorup T, Hansen JM. Observer variation in the clinical assessment of the thyroid gland. Journal of Internal Medicine. 1991;229:159–161
  65. Hammings JF, Goslings BM, van Steenis FJ, et al. The value of fine-needle aspiration biopsy in patients with nodular thyroid disease divided into groups of suspicion of malignant neoplasms on clinical grounds. Archives of Internal Medicine. 1990;150:113–116
  66. Hermus AR, Huysmans DA, Van Herle AJ, et al. Treatment of benign nodular thyroid disease. New England Journal of Medicine. 1998;338:1438–1447
  67. Gharib H, Mazzaferri EL. Thyroxine suppressive therapy in patients with nodular thyroid disease. Annals of Internal Medicine. 1998;128:386–394
  68. Girelli ME, De Vido D. Serum thyroglobulin measurements in differentiated thyroid cancer. Biomedicine and Pharmacotherapy. 2000;54:330–333
  69. Hamy A, Mirallie E, Bennouna J, et al. Thyroglobulin monitoring after treatment of well-differentiated thyroid cancer. European Journal of Surgical Oncology. 2004;30:681–685
  70. Brauckhoff M, Lorenz K, Ukkat J, et al. Medullary thyroid carcinoma. Scandinavian Journal of Surgery. 2004;93:249–260
  71. Elisei R, Bottici V, Luchetti F, et al. Impact of routine measurement of serum calcitonin on the diagnosis and outcome of medullary thyroid cancer: experience in 10.864 patients with nodular thyroid disorders. Journal of Clinical Endocrinology and Metabolism. 2004;89:163–168
  72. Gibelin J, Essique D, Jones C, et al. Increased calcitonin levels in thyroid nodules without medullary carcinoma. British Journal of Surgery. 2005;92:574–578
  73. Baskin HJ. New applications of thyroid and parathyroid ultrasound. Minerva Endocrinology. 2004;29:195–206
  74. Mandel SJ. Diagnostic use of ultrasonography in patients with nodular thyroid disease. Endocrine Practice. 2004;10:246–252
  75. Brander A, Viikinkoski P, Nickels J, Kivisaari L. Thyroid glands: US screening in a random adult population. Radiology. 1991;181:683–687
  76. Hegedus L. Thyroid ultrasound. Endocrinology Metabolism and Clinics of North America. 2001;30:339–360
  77. Sakorafas GH, Giotakis J, Stafyla V. Papillary thyroid microcarcinoma: a surgical perspective. Cancer Treatment Review. 2005;31:423–438
  78. Giuffrida D, Gharib H. Controversies in the management of cold, hot, and occult thyroid nodules. American Journal of Medicine. 1995;99:642–650
  79. Smith JR, Oates E. Radionuclide imaging of the thyroid gland: patterns, pearls, and pitfalls. Clinical Nuclear Medicine. 2004;29:181–193
  80. Shambaugh DE III, Quinn JL, Oyasu R, Freinkel N. Disparate thyroid imaging: combined studies with sodium pertechnetate Tc99m and radioactive iodine. Journal of the American Medical Association. 1974;228:866–869
  81. Gharib H, Goellner JR, Zinsmeister AR, et al. Fine-needle aspiration biopsy of the thyroid: a problem of suspicious cytologic findings. Annals of Internal Medicine. 1984;101:25–30
  82. 〈www.thyroid.org/professionals/publications/guidelines.html〉.
  83. 〈www.aace.com/clin/guidelines/thyroid_nodules.pdf〉.
  84. Jennings A. Evaluation of substernal goiters using computed tomography and MR imaging. Endocrinology and Metabolism Clinics North America. 2001;30:401–414
  85. Weber AL, Randolph G, Aksoy FG. The thyroid and parathyroid glands. CT and MR imaging and correlation with pathology and clinical findings. Radiologic Clinics of North America. 2000;38:1105–1129
  86. Bouvet M, Feldman JI, Gill GN, et al. Surgical management of the thyroid nodule: patient selection based on the results of fine-needle aspiration cytology. Laryngoscope. 1992;102:1353–1356
  87. Lin JD, Chao TC, Huang BY, et al. Thyroid cancer in the thyroid nodules evaluated by ultrasonography and fine-needle aspiration cytology. Thyroid. 2005;15:708–717
  88. Zagorianakou P, Malamou-Mitsi V, Zagorianakou N, et al. The role of fine-needle aspiration biopsy in the management of patients with thyroid nodules. In Vivo. 2005;19:605–609
  89. Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Annals of Internal Medicine. 1993;118:282–289
  90. Caruso D, Mazzaferri EL. Fine-needle aspiration biopsy in the management of thyroid nodules. Endocrinologist. 1991;1:194–202
  91. Gharib H, Goellner JR, Johnson DA. Fine-needle aspiration cytology of the thyroid: a 12-year experience with 11.000 biopsies. Clinics in Laboratory Medicine. 1991;13:699–709
  92. Caplan RH, Kisken WA, Strutt PJ, et al. Fine-needle aspiration biopsy of thyroid nodules: a cost-effective diagnostic plan. Postgraduate Medicine. 1991;90:183–190
  93. Danese D, Sciacchitano S, Farsetti A, et al. Diagnostic accuracy of conventional vs. sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid. 1998;8:15–21
  94. Baskin HJ. Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules and multinodular goiters. Endocrine Practice. 2004;10:242–245
  95. Choi KU, Kim JY, Park do Y, et al. Recommendations for the management of cystic thyroid nodules. Australian and New Zealand Journal of Surgery. 2005;75:537–541
  96. Smith MD, Serpell JW, Morgan JL, Cheng MS. Fine needle aspiration in the management of benign thyroid cysts. Australian and New Zealand Journal of Surgery. 2003;73:477–479
  97. Bellantone R, Lombardi CP, Raffaelli M, et al. Management of cystic or predominantly cystic thyroid nodules: the role of ultrasound-guided fine-needle aspiration biopsy. Thyroid. 2004;14:43–47
  98. Tyler DS, Winchester DJ, Caraway NP, et al. Indeterminate fine-needle aspiration biopsy of the thyroid: identification of subgroups at high risk for invasive carcinoma. Surgery. 2004;116:1054–1060
  99. Castro MR, Gharib H. Continuing controversies in the management of thyroid nodules. Annals of Internal Medicine. 2005;142:926–931
  100. Ortiz R, Hupart KH, DeFesi CR, Surks MI. Effect of early referral to an endocrinologist on efficiency and cost of evaluation and development of treatment plan in patients with thyroid nodules. Journal of Clinical Endocrinology and Metabolism. 1998;83:3803–3807
  101. Castro MR, Gharib H. Thyroid nodules and cancer. When to wait and watch, when to refer. Postgradute Medicine. 2000;107:113–116
  102. Leonard N, Melcher DH. To operate or not to operate? The value of FNA cytology in the assessment of thyroid swellings. Journal of Clinical Pathology. 1997;50:941–943
  103. Hooft L, Hoekstra OS, Boers M, et al. Practice, efficacy, and costs of thyroid nodule evaluation: a retrospective study in a Dutch university hospital. Thyroid. 2004;14:287–293

PII: S0960-7404(06)00027-2

doi: 10.1016/j.suronc.2006.07.001

Surgical Oncology
Volume 15, Issue 1 , Pages 43-55 , July 2006

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