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Thyroid Nodules

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Thyroid Cancer

Part of the book series: Endocrine Updates ((ENDO,volume 32))

Abstract

Thyroid nodules are quite common, and are often discovered as an incidental finding on a physical examination, through imaging modalities or at autopsy. The vast majority of these nodules are benign and do not require any specific therapy. Thyroid nodules are evaluated in order to see if the lesion is benign or malignant, or, in a patient with hyperthyroidism, to see if the nodule is the source of excessive thyroid hormone. In addition to important historical details, a neck examination, serum TSH measurement, and, in some instances, a serum calcitonin measurement, with a thyroid and neck ultrasonography, provide a substantial amount of important information which will direct subsequent evaluation, including the need for a fine-needle-aspiration biopsy of the lesion(s). The management of the nodule is dictated by these findings and subsequent behavior.

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References

  1. Vander JB, Gaston EA, Dawber TR. Significance of solitary nontoxic nodules; preliminary report. New Engl J Med. 1954;251:970–3.

    CAS  PubMed  Google Scholar 

  2. Vander JB, Gaston EA, Dawber TR. The significance of nontoxic thyroid nodules. Final report of a 15 year study of the incidence of thyroid malignancy. Ann Intern Med. 1968;69:537–40.

    CAS  PubMed  Google Scholar 

  3. Turnbridge WMG, Evered DC, Hall R, et al. The spectrum of thyroid disease in a community: the Whickham Survey. Clin Endocrinol (Oxf). 1977;7:481–93.

    Google Scholar 

  4. Brader A, Viikinkiski P, Nickels J, et al. Thyroid gland: US screening in a random adult population. Radiology. 1991;181:683–7.

    Google Scholar 

  5. Wiest PW, Hartshorne MF, Inskip PD, et al. Thyroid palpation versus high-resolution thyroid ultrasonography in the detection of nodules. J Ultrasound Med. 1998;17:487–96.

    CAS  PubMed  Google Scholar 

  6. Ezzat S, Sarti DA, Cain DR, et al. Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch Intern Med. 1994;154:1838–40.

    CAS  PubMed  Google Scholar 

  7. Carroll BA. Asymptomatic thyroid nodules: incidental sonographic detection. Am J Roentgenol. 1982;138:499–501.

    CAS  Google Scholar 

  8. Horlocker TT, Hay ID. Prevalence of incidental nodular thyroid disease detected during high-resolution parathyroid sonography. In: Medeiros-Neto G, Gaitan E, editors. Frontiers in thyroidology, vol. 2. New York, NY: Plenum; 1985. p. 1309–12.

    Google Scholar 

  9. Stark DD, Clark OH, Gooding GAW, et al. High-resolution ultrasonography and computed tomography of thyroid lesions in patients with hyperparathyroidism. Surgery. 1983;94:863–8.

    CAS  PubMed  Google Scholar 

  10. Woestyn J, Afschrift M, Schelstraete K, et al. Demonstration of nodules in the normal thyroid by echography. Br J Radiol. 1985;58:1179–82.

    CAS  PubMed  Google Scholar 

  11. Tomimori E, Pedrinola F, Cavaliere H, et al. Prevalence of incidental thyroid disease in a relatively low iodine intake area. Thyroid. 1995;5:273–6.

    CAS  PubMed  Google Scholar 

  12. Struve C, Hinrichs J. Schilddrusenvolumina und Haufigkeit herdformiger Veranderungen bei schilddrusengesunden Mannern und Frauen verschiedener Altersklassen. Dtsch Med Wochenschr. 1989;114:283–7.

    CAS  PubMed  Google Scholar 

  13. Bruneton JN, Balu-Maestro C, Marcy PY, et al. Very high frequency (13 MHz) ultrasonographic examination of the normal neck: detection of normal lymph nodes and thyroid nodules. J Ultrasound Med. 1994;13:87–90.

    CAS  PubMed  Google Scholar 

  14. Mortenson JD, Woolner LB, Bennett WA. Gross and microscopic findings in clinically normal thyroid glands. J Clin Endocrinol Metab. 1955;15:1270–80.

    Google Scholar 

  15. Furmanchuk AW, Roussak N, Ruchti C. Occult thyroid carcinoma in the region of Minsk, Belarus. An autopsy study of 215 patients. Histopathology. 1993;23:319–25.

    CAS  PubMed  Google Scholar 

  16. Rice CO. Incidence of nodules in the thyroid: a comparative study of symptomless thyroid glands removed at autopsy and hyperfunctioning goiters operatively removed. Arch Surg. 1932;24:505–15.

    Google Scholar 

  17. Hellwig CA. The thyroid gland in Kansas. Am J Clin Pathol. 1935;5:103–11.

    Google Scholar 

  18. Schlesinger MJ, Gargill SL, Saxe IH. Studies in nodular goiter: incidence of thyroid nodules in routine necropsies in a nongoitrous region. JAMA. 1938;110:1638–41.

    Google Scholar 

  19. Hull OH. Critical analysis of two hundred twenty-one thyroid glands: study of thyroid glands obtained at necropsy in Colorado. Arch Pathol. 1955;59:291–311.

    CAS  Google Scholar 

  20. Ortel JE, Klinck GH. Structural changes in the thyroid glands of healthy young men. Med Ann Dist Columbia. 1965;34:75–7.

    Google Scholar 

  21. Takahashi T, Trott KR, Fujimori K, et al. An investigation into the prevalence of thyroid disease on Kwajalein Atoll, Marshall Islands. Health Phys. 1997;73:199–213.

    CAS  PubMed  Google Scholar 

  22. McCall A, Jarosz H, Lawrence AM, et al. The incidence of thyroid carcinoma in solitary cold nodules and in multinodular goiters. Surgery. 1986;100:1128–32.

    CAS  PubMed  Google Scholar 

  23. Belfiore A, La Rosa GL, La Porta GA, et al. Cancer risk in patients with cold nodules: relevance of iodine intake, sex, age and multinodularity. Am J Med. 1992;93:363–9.

    CAS  PubMed  Google Scholar 

  24. Cochand-Priollet B, Guillausseau PJ, Chagnon S, et al. The diagnostic value of fine-needle aspiration biopsy under ultrasonography in nonfunctional thyroid nodules: a prospective study comparing cytologic and histologic findings. Am J Med. 1994;97:152–7.

    CAS  PubMed  Google Scholar 

  25. Sachmechi I, Miller E, Varatharajah R, et al. Thyroid carcinoma in single cold nodules and in cold nodules of multinodular goiters. Endocr Pract. 2000;6:5–7.

    CAS  PubMed  Google Scholar 

  26. Marqusee E, Benson CB, Frates MC, et al. Usefulness of ultrasonography in the management of nodular thyroid disease. Ann Intern Med. 2000;133:696–700.

    CAS  PubMed  Google Scholar 

  27. Papini E, Guglielmi R, Bianchini A, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab. 2002;87:1941–6.

    CAS  PubMed  Google Scholar 

  28. Deandrea M, Mormile A, Veglio M, et al. Fine-needle aspiration biopsy of the thyroid: comparison between thyroid palpation and ultrasonography. Endocr Pract. 2002;8:282–6.

    PubMed  Google Scholar 

  29. Frates MC, Benson CB, Doubilet PM, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clin Endocrinol Metab. 2006;91:3411–7.

    CAS  PubMed  Google Scholar 

  30. Nam-Goong IS, Kim HY, Gong G, et al. Ultrasonography-guided fine-needle aspiration of thyroid incidentaloma: correlation with pathological findings. Clin Endocrinol. 2004;60:21–8.

    Google Scholar 

  31. Silverberg SG, Vidone RA. Carcinoma of the thyroid in surgical and postmortem material. Analysis of 300 cases at autopsy and literature review. Ann Surg. 1966;164:291–2.

    CAS  PubMed  Google Scholar 

  32. Farooki MA. Epidemiology and pathology of cancer of the thyroid. Int Surg. 1969;51:232–43.

    CAS  PubMed  Google Scholar 

  33. Sampson RJ, Key CR, Buncher CR, et al. Thyroid carcinoma in Hiroshima and Nagasaki. I. Prevalence of thyroid carcinoma at autopsy. JAMA. 1969;209:65–70.

    CAS  PubMed  Google Scholar 

  34. Sampson RJ, Woolner LB, Bahn RC, et al. Occult thyroid carcinoma in Olmstead County, Minnesota: prevalence at autopsy compared with that in Hiroshima and Nagasaki, Japan. Cancer. 1974;34:2072–6.

    CAS  PubMed  Google Scholar 

  35. Fukunaga FH, Yatani R. Geographic pathology of occult thyroid carcinoma. Cancer. 1975;36:1095–9.

    CAS  PubMed  Google Scholar 

  36. Sobrinho-Simoes MA, Sambade MC, Goncalves V. Latent thyroid carcinoma at autopsy. Cancer. 1979;43:1702–6.

    CAS  PubMed  Google Scholar 

  37. Bondeson L, Ljungberg O. Occult thyroid carcinoma at autopsy in Malmo, Sweden. Cancer. 1981;47:319–23.

    CAS  PubMed  Google Scholar 

  38. Pingitore R. Rilievi morfologici autopsicisu 111 tiroidi clinicamente normali in un`area italiana senza edemia gozzigena. Pathologica. 1982;74:545–52.

    CAS  PubMed  Google Scholar 

  39. Arellano L, Ibarra A. Occult carcinoma of the thyroid gland. Pathol Res Pract. 1984;179:88–91.

    CAS  PubMed  Google Scholar 

  40. Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of the thyroid. A “normal” finding in Finland. A systematic autopsy study. Cancer. 1985;56:531–8.

    CAS  PubMed  Google Scholar 

  41. Franssila KO, Harach HR. Occult papillary carcinoma of the thyroid in children and young adults. A systemic autopsy study in Finland. Cancer. 1986;58:715–9.

    CAS  PubMed  Google Scholar 

  42. Lang W, Borrusch H, Bauer L. Occult carcinomas of the thyroid. Evaluation of 1020 sequential autopsies. Am J Clin Pathol. 1988;90:72–6.

    CAS  PubMed  Google Scholar 

  43. Ottino A, Pianzola HM, Castelletto RH. Occult papillary thyroid carcinoma at autopsy in La Plata, Argentina. Cancer. 1989;64:547–51.

    CAS  PubMed  Google Scholar 

  44. Yamamoto Y. Occult papillary carcinoma of the thyroid. A study of 408 autopsy cases. Cancer. 1990;65:1173–9.

    CAS  PubMed  Google Scholar 

  45. Loh KC. Familial nonmedullary thyroid carcinoma: a meta-review of case series. Thyroid. 1997;7:107–13.

    CAS  PubMed  Google Scholar 

  46. DeGroot LJ, Frohman LA, Kaplan EL, et al. Radiation-associated thyroid carcinoma. New York: Gruene & Stratton; 1977.

    Google Scholar 

  47. Mihailescu DV, Schneider AB. Size, number, and distribution of thyroid nodules and the risk of malignancy in radiation-exposed patients who underwent surgery. J Clin Endocrinol Metab. 2008;93:2188–93.

    CAS  PubMed  Google Scholar 

  48. Pacini F, Vorontsova T, Demidchik E, et al. Post-Chernobyl thyroid carcinoma in Belarus children and adolescents: comparison with naturally occuring thyroid carcinoma in Italy and France. J Clin Endocrinol Metab. 1997;81:3563–9.

    Google Scholar 

  49. Curtis RE, Rowlings PA, Deeg HJ, et al. Solid cancers after bone marrow transplantation. N Engl J Med. 1997;336:897–904.

    CAS  PubMed  Google Scholar 

  50. Hegedüs L. The thyroid nodule. N Engl J Med. 2004;351:1764–71.

    PubMed  Google Scholar 

  51. Gharib H, Papini E, Valcavi R, Baskin HJ, Crescenzi A, Dottorini ME. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract. 2006;12:63–102.

    PubMed  Google Scholar 

  52. Niedziela M. Pathogenesis, diagnosis and management of thyroid nodules in children. Endocr Relat Cancer. 2006;13:427–53.

    CAS  PubMed  Google Scholar 

  53. Boelaert K, Horacek J, Holder RL, et al. Serum thyrotropin concentration as a novel predictor of malignancy in thyroid nodules investigated by fine-needle aspiration. J Clin Endocrinol Metab. 2006;91:4295–301.

    CAS  PubMed  Google Scholar 

  54. Kim WB, Han SM, Kim TY, et al. Ultrasonographic screening for detection of thyroid cancer in patients with Graves’ disease. Clin Endocrinol (Oxf). 2004;60:719–25.

    Google Scholar 

  55. Hegedüs L, Bonnema SJ, Bennedbæk FN. Management of simple nodular goiter: current status and future prospectives. Endocr Rev. 2003;24:102–32.

    PubMed  Google Scholar 

  56. Kloos RT, Eng C, Evans DB, et al. Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid. 2009;19:565–612.

    PubMed  Google Scholar 

  57. Pacini F, Fontanelli M, Fugazzola L, et al. Routine measurement of serum calcitonin in nodular thyroid disease allows the preoperative diagnosis of unsuspected sporadic medullary thyroid carcinoma. J Clin Endocrinol Metab. 1994;78:826–9.

    CAS  PubMed  Google Scholar 

  58. Rieu M, Lame MC, Richard A, et al. Prevalence of sporadic medullary thyroid carcinoma: the importance of routine measurement of serum calcitonin in the diagnostic evaluation of thyroid nodules. Clin Endocrinol (Oxf). 1995;42:453–60.

    CAS  Google Scholar 

  59. Niccoli P, Wion-Barbot N, Caron P, et al. Interest of routine measurement of serum calcitonin: study in a large series of thyroidectomized patients. The French Medullary Study Group. J Clin Endocrinol Metab. 1997;82:338–41.

    CAS  PubMed  Google Scholar 

  60. Vierhapper H, Reber W, Bieglmayer C, et al. Routine measurement of plasma calcitonin in nodular thyroid diseases. J Clin Endocrinol Metab. 1997;82:1589–93.

    CAS  PubMed  Google Scholar 

  61. Ozgen AG, Hamulu F, Bayraktar F, et al. Evaluation of routine basal serum calcitonin measurement for early diagnosis of medullary thyroid carcinoma in seven hundred seventy-three patients wih nodular goiter. Thyroid. 1999;9:579–82.

    CAS  PubMed  Google Scholar 

  62. Hahm JR, Lee MS, Min YK, et al. Routine measurement of serum calcitonin is useful for early detection of medullary thyroid carcinoma in patients with nodular thyroid diseases. Thyroid. 2001;11:73–80.

    CAS  PubMed  Google Scholar 

  63. 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. J Clin Endocrinol Metab. 2004;89:163–8.

    CAS  PubMed  Google Scholar 

  64. Costante G, Meringolo D, Durante C, et al. Predictive value of serum calcitonin levels for preoperative diagnosis of medullary thyroid carcinoma in a cohort of 5817 consecutive patients with thyroid nodules. J Clin Endocrinol Metab. 2007;92:450–5.

    CAS  PubMed  Google Scholar 

  65. Rink T, Truong P-N, Schroth H-J, et al. Calculation and validation of a plasma calcitonin limit for early detection of medullary thyroid carcinoma in nodular thyroid disease. Thyroid. 2009;19:327–32.

    CAS  PubMed  Google Scholar 

  66. Bugalho MJ, Santos JR, Sobrinho L. Preoperative diagnosis of medullary thyroid carcinoma: fine needle aspiration cytology as compared with serum calcitonin measurement. J Surg Oncol. 2005;91:56–60.

    PubMed  Google Scholar 

  67. Pacini F, Schlumberger M, Dralle H, et al. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol. 2006;154:787–803 [Erratum (2006) 155:385].

    CAS  PubMed  Google Scholar 

  68. Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–215.

    PubMed  Google Scholar 

  69. Elisei R. Routine serum calcitonin measurement in the evaluation of thyroid nodules. Best Pract Res Clin Endocrinol Metab. 2008;22:941–53.

    CAS  PubMed  Google Scholar 

  70. Bennedbæk FN, Perrild H, Hegedüs L. Diagnosis and treatment of the solitary thyroid nodule. Results of a European survey. Clin Endocrinol (Oxf). 1999;50:357–63.

    Google Scholar 

  71. Bennedbæk FN, Hegedüs L. Management of the solitary thyroid nodule: results of a North American survey. J Clin Endocrinol Metab. 2000;85:2493–8.

    PubMed  Google Scholar 

  72. Bonnema SJ, Bennedbæk FN, Wiersinga WM, et al. Management of the nontoxic multinodular goitre: a European questionnaire study. Clin Endocrinol (Oxf). 2000;53:5–12.

    CAS  Google Scholar 

  73. Bonnema SJ, Bennedbæk FN, Ladenson PW, et al. Management of the nontoxic multinodular goiter: a North American survey. J Clin Endocrinol Metab. 2002;87:112–7.

    CAS  PubMed  Google Scholar 

  74. Cheung K, Roman SA, Wang TS, et al. Calcitonin measurement in the evaluation of thyroid nodules in the United States: a cost-effectiveness and decision analysis. J Clin Endocrinol Metab. 2008;93:2173–80.

    CAS  PubMed  Google Scholar 

  75. Khoo ML, Asa SL, Witterick IJ, et al. Thyroid calcification and its association with thyroid carcinoma. Head Neck. 2002;24:651–5.

    PubMed  Google Scholar 

  76. Kim EK, Park CS, Chung WY, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. Am J Roentgenol. 2002;178:687–91.

    Google Scholar 

  77. Peccin S, de Castro JA, Furlanetto TW, et al. Ultrasonography: is it useful in the diagnosis of cancer in thyroid nodules? J Endocrinol Invest. 2002;25:39–43.

    CAS  PubMed  Google Scholar 

  78. Frates MC, Benson CB, Doubilet PM, et al. Can color Doppler sonography aid in the prediction of malignancy of thyroid nodules? J Ultrasound Med. 2003;22:127–31.

    PubMed  Google Scholar 

  79. Leenhardt L, Hejblum G, Franc B, et al. Indications and limits of ultrasound-guided cytology in the management of nonpalpable thyroid nodules. J Clin Endocrinol Metab. 1999;84:24–8.

    CAS  PubMed  Google Scholar 

  80. Cappelli C, Castellano M, Pirola I, et al. The predictive value of ultrasound findings in the managment of thryoid nodules. QJM. 2007;100:29–35.

    CAS  PubMed  Google Scholar 

  81. Moon WJ, Jung SL, Lee JH, et al. Benign and malignant thyroid nodules: US differentiation – multicenter retrospective study. Radiology. 2008;247:762–70.

    PubMed  Google Scholar 

  82. Kang HW, No JH, Chung JH, et al. Prevalence, clinical and ultrasonographic characteristics of thyroid incidentalomas. Thyroid. 2004;14:29–33.

    PubMed  Google Scholar 

  83. Shimura H, Haraguchi K, Hiejima Y, et al. Distinct diagnostic criteria for ultrasonographic examination of papillary thyroid carcinoma: a multicenter study. Thyroid. 2005;15:251–8.

    PubMed  Google Scholar 

  84. Ito Y, Amino N, Yokozawa T, et al. Ultrasonographic evaluation of thyroid nodules in 900 patients: comparison among ultrasonographic, cytological, and histological findings. Thyroid. 2007;17:1269–76.

    PubMed  Google Scholar 

  85. Park J-Y, Lee HJ, Jang HW, et al. A proposal for a thyroid imaging reporting and data system for ultrasound features of thryoid carcinoma. Thyroid. 2009;19:1257–64.

    PubMed  Google Scholar 

  86. Horvath E, Majlis S, Rossi R, et al. An ultrasound reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab. 2009;90:1748–51.

    Google Scholar 

  87. Frates MC, Benson CB, Charboneau JW, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology. 2005;237:794–800.

    PubMed  Google Scholar 

  88. Kim TY, Kim WB, Ryu JS, et al. 18 F-fluorodeoxyglucose uptake in thyroid from positron emission tomogram (PET) for evaluation in cancer patients: high prevalence of malignancy in thyroid PET incidentaloma. Laryngoscope. 2005;115:1074–8.

    PubMed  Google Scholar 

  89. Korun N, Asci C, Yilmazlar T, et al. Total thyroidectomy or lobectomy in benign nodular disease of the thyroid: changing trends in surgery. Int Surg. 1997;82:417–9.

    CAS  PubMed  Google Scholar 

  90. Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med. 1993;328:553–9.

    CAS  PubMed  Google Scholar 

  91. Castro MR, Gharib H. Continuing controversies in the management of thyroid nodules. Ann Intern Med. 2005;142:926–31.

    PubMed  Google Scholar 

  92. Goellner JR, Gharib H, Grant CS, et al. Fine needle aspiration cytology of the thyroid, 1980 to 1986. Acta Cytol. 1987;31:587–90.

    CAS  PubMed  Google Scholar 

  93. Takashima S, Fukuda H, Kobayashi T. Thyroid nodules: clinical effect of ultrasound-guided fine-needle aspiration biopsy. J Clin Ultrasound. 1994;22:535–42.

    CAS  PubMed  Google Scholar 

  94. Carmeci C, Jeffrey RB, McDougall IR, et al. Ultrasound-guided fine-needle aspiration biopsy of thyroid masses. Thyroid. 1998;8:283–9.

    CAS  PubMed  Google Scholar 

  95. Danese D, Sciacchitano S, Farsetti A, et al. Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid. 1998;8:15–21.

    CAS  PubMed  Google Scholar 

  96. Hatada T, Okada K, Ishii H, et al. Evaluation of ultrasound-guided fine-needle aspiration biopsy for thyroid nodules. Am J Surg. 1998;175:133–6.

    CAS  PubMed  Google Scholar 

  97. Cochand-Priollet B, Guillausseau PJ, Chagnon S, et al. The diagnostic value of fine-needle aspiration biopsy under ultrasonography in nonfunctional thyroid nodules: a prospective study comparing cytologic and histologic findings. Am J Med. 1994;97:152–7.

    CAS  PubMed  Google Scholar 

  98. Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med. 1993;118:282–9.

    CAS  PubMed  Google Scholar 

  99. Alexander EK, Heering JP, Benson CB, et al. Assessment of nondiagnostic ultrasound-guided fine needle aspiration of thyroid nodules. J Clin Endocrinol Metab. 2002;87:4924–7.

    CAS  PubMed  Google Scholar 

  100. Baloch ZW, Cibas ES, Clark DP, et al. The National Cancer Institute thyroid fine needle aspiration state of the science conference: a summation. Cytojournal. 2008;5:6.

    PubMed Central  PubMed  Google Scholar 

  101. Haugen BR, Woodmansee WW, McDermott MT. Towards improving the utility of fine-needle aspiration biopsy for the diagnosis of thyroid tumors. Clin Endocrinol (Oxf). 2002;56:281–90.

    CAS  Google Scholar 

  102. Sapio MR, Posca D, Raggioli A, et al. Detection of RET/PTC, TRK and BRAF mutations in preoperative diagnosis of thyroid nodules with indeterminate cytological findings. Clin Endocrinol (Oxf). 2007;66:678–83.

    CAS  Google Scholar 

  103. Nikiforov YE, Nikiforov YE, Steward DL, et al. Molecular testing for mutations in improving the fine-needle aspiration diagnosis of thyroid nodules. J Clin Endocrinol Metab. 2009;94:2092–8.

    CAS  PubMed  Google Scholar 

  104. Ylagan LR, Farkas T, Dehner LP. Fine needle aspiration of the thyroid: a cytohistologic correlation and study of discrepant cases. Thyroid. 2004;14:35–41.

    PubMed  Google Scholar 

  105. Kuma K, Matsuzuka F, Kibayashi A, et al. Outcome of long standing solitary thyroid nodules. World J Surg. 1992;16:583–7.

    CAS  PubMed  Google Scholar 

  106. Bennedbæk FN, Nielsen LK, Hegedüs L. Effect of percutaneous ethanol injection therapy vs. suppressive doses of L-thyroxine on benign solitary solid cold thyroid nodules: a randomized trial. J Clin Endocrinol Metab. 1998;83:30–5.

    Google Scholar 

  107. Alexander EK, Hurwitz S, Heering JP, et al. Natural history of benign solid and cystic thyroid nodules. Ann Intern Med. 2003;138:315–8.

    PubMed  Google Scholar 

  108. Asanuma K, Kobayashi S, Shingu K, et al. The rate of tumour growth does not distinguish between malignant and benign thyroid nodules. Eur J Surg. 2001;167:102–5.

    CAS  PubMed  Google Scholar 

  109. Brauer VF, Eder P, Miehle K, et al. Interobserver variation for ultrasound determination of thyroid nodule volumes. Thyroid. 2005;15:1169–75.

    CAS  PubMed  Google Scholar 

  110. Shimoaka K, Sokal JE. Suppressive therapy of nontoxic goiter. Am J Med. 1974;57:576–83.

    Google Scholar 

  111. Celani MF, Mariani M, Mariani G. On the usefulness of levothyroxine suppressive therapy in the medical treatment of benign solitary, solid or predominantly solid, thyroid nodules. Acta Endocrinol (Copenh). 1990;123:603–8.

    CAS  Google Scholar 

  112. Lima N, Knobel M, Cavaliere H, et al. Levothyroxine suppressive therapy is partially effective in treating patients with benign, solid thyroid nodules and multinodular goiters. Thyroid. 1997;7:691–7.

    CAS  PubMed  Google Scholar 

  113. La Rosa GL, Lupo I, Giuffrida D, et al. Levothyroxine and potassium iodide are both effective in treating benign solitary solid cold nodules of the thyroid. Ann Intern Med. 1995;122:1–8.

    PubMed  Google Scholar 

  114. Zelmanovitz F, Genro S, Gross JL. Suppressive therapy with levothyroxine for solitary thyroid nodules: a double-blind controlled clinical study and cumulative meta-analysis. J Clin Endocrinol Metab. 1998;83:3881–5.

    CAS  PubMed  Google Scholar 

  115. Wémeau JL, Caron P, Schvartz C, et al. Effects of thyroid-stimulating hormone suppression with levothyroxine in reducing the volume of solitary ­thyroid nodules and improving extranodular nonpalpable changes: a randomized, double-blind, placebo-­controlled trial by the French Thyroid Research Group. J Clin Endocrinol Metab. 2002;87:4928–34.

    PubMed  Google Scholar 

  116. Papini E, Petrucci L, Guglielmi R, et al. Long-term changes in nodular goiter: a 5-year prospective randomised trial of levothyroxine suppressive therapy for benign cold thyroid nodules. J Clin Endocrinol Metab. 1998;83:780–3.

    CAS  PubMed  Google Scholar 

  117. Gharib H, James EM, Charboneau JW, et al. Suppressive therapy with levothyroxine for solitary thyroid nodules. A double-blind controlled clinical study. N Engl J Med. 1987;317:70–5.

    CAS  PubMed  Google Scholar 

  118. Larijani B, Pajouhi M, Bastanhagh MH, et al. Evaluation of suppressive therapy for cold thyroid nodules with levothyroxine: double-blind, placebo-controlled clinical trial. Endocr Pract. 1999;5:251–6.

    CAS  PubMed  Google Scholar 

  119. Castro MR, Caraballo PJ, Morris JC. Effectiveness of thyroid hormone suppressive therapy in benign solitary thyroid nodules: a meta-analysis. J Clin Endocrinol Metab. 2002;87:4154–9.

    CAS  PubMed  Google Scholar 

  120. La Rosa GL, Ippolito AM, Lupo L, et al. Cold thyroid nodule reduction with L-thyroxine can be predicted by initial nodule volume and cytological characteristics. J Clin Endocrinol Metab. 1996;81:4385–7.

    PubMed  Google Scholar 

  121. Csako G, Byrd D, Wesley RA, et al. Assessing the effects of thyroid suppression on benign solitary thyroid nodules. A model for using quantitative research synthesis. Medicine (Baltimore). 2000;79:9–26.

    CAS  Google Scholar 

  122. Richter B, Neises G, Clar C. Pharmacotherapy for thyroid nodules. A systemic review and meta-analysis. Endocrinol Metab Clin. 2002;31:699–722.

    Google Scholar 

  123. Subbiah S, Collins BJ, Schneider AB. Factors related to the recurrence of thyroid nodules after surgery for benign radiation-related nodules. Thyroid. 2007;17:41–7.

    PubMed  Google Scholar 

  124. Gharib H, Mazzaferri EL. Thyroxine suppressive therapy in patients with nodular thyroid disease. Ann Intern Med. 1998;128:386–94.

    CAS  PubMed  Google Scholar 

  125. Faber J, Galloe AM. Changes in bone mass during prolonged subclinical hyperthyroidism due to L-thyroxine treatment: a meta-analysis. Eur J Endocrinol. 1994;130:350–6.

    CAS  PubMed  Google Scholar 

  126. Uzzan B, Campos J, Cucherat M, et al. Effects on bone mass of long term treatment with thyroid hormones: a meta-analysis. J Clin Endocrinol Metab. 1996;81:4278–89.

    CAS  PubMed  Google Scholar 

  127. Sawin CT, Geller A, Wolf PA, et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med. 1994;331:1249–52.

    CAS  PubMed  Google Scholar 

  128. Perle JV, Maisonneuve P, Sheppard MC, et al. Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10 year cohort study. Lancet. 2001;358:861–5.

    Google Scholar 

  129. Tuttle RM, Lemar H, Burch HB. Cinical features associated with an increased risk of thyroid malignancy in patients with follicular neoplasia by fine-needle aspiration. Thyroid. 1998;8:377–83.

    CAS  PubMed  Google Scholar 

  130. 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. 1994;116:1054–60.

    CAS  PubMed  Google Scholar 

  131. Kelman AS, Rathan A, Leibowitz J, et al. Thyroid cytology and the risk of malignancy in thyroid nodules: importance of nuclear atypia in indeterminate specimens. Thyroid. 2001;11:271–7.

    CAS  PubMed  Google Scholar 

  132. Tisell LE, Nilsson B, Molne J, et al. Improved survival of patients with papillary thyroid cancer after surgical microdissection. World J Surg. 1996;20:854–9.

    CAS  PubMed  Google Scholar 

  133. Sywak M, Cornford L, Roach P, et al. Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery. 2006;140:1000–7.

    PubMed  Google Scholar 

  134. Moser E. Radioiodine treatment of Plummer’s disease. Exp Clin Endocrinol Diabetes. 1998;106 Suppl 4:S63–5.

    CAS  PubMed  Google Scholar 

  135. Nygaard B, Hegedüs L, Nielsen KG, et al. Long-term effect of radioactive iodine on thyroid function and size in patients with solitary autonomously functioning toxic thyroid nodules. Clin Endocrinol (Oxf). 1999;50:197–202.

    CAS  Google Scholar 

  136. Ferrari C, Reschini E, Paracchi A. Treatment of the autonomous thyroid nodule: a review. Eur J Endocrinol. 1996;135:383–90.

    CAS  PubMed  Google Scholar 

  137. Mariotti S, Martino E, Francesconi M, et al. Serum thyroid autoantibodies as a risk factor for development of hypothyroidism after radioactive iodine therapy for single thyroid ‘hot’ nodule. Acta Endocrinol (Copenh). 1986;113:500–7.

    CAS  Google Scholar 

  138. Goldstein R, Hart IR. Follow-up of solitary autonomous thyroid nodules treated with 131I. N Engl J Med. 1983;309:1473–6.

    CAS  PubMed  Google Scholar 

  139. Lippi F, Ferrari C, Manetti L, et al. Treatment of solitary autonomous thyroid nodules by percutaneous ethanol injection: results of an Italian multicenter study. J Clin Endocrinol Metab. 1996;81:3261–4.

    CAS  PubMed  Google Scholar 

  140. Verde G, Papini E, Pacella CM, et al. Ultrasound guided percutaneous ethanol injection in the treatment of cystic thyroid nodules. Clin Endocrinol (Oxf). 1994;41:719–24.

    CAS  Google Scholar 

  141. Bennedbæk FN, Karstrup S, Hegedüs L. Percutaneous ethanol injection therapy in the treatment of thyroid and parathyroid diseases. Eur J Endocrinol. 1997;136:240–50.

    PubMed  Google Scholar 

  142. Livraghi T, Paracchi A, Ferrari C, et al. Treatment of autonomous thyroid nodules with percutaneous ethanol injection: preliminary results: work in progress. Radiology. 1990;175:827–9.

    CAS  PubMed  Google Scholar 

  143. Papini E, Pacella CM, Verde G. Percutaneous ethanol injection (PEI): what is its role in the treatment of benign thyroid nodules? Thyroid. 1995;5:147–50.

    CAS  PubMed  Google Scholar 

  144. Valcavi R, Frasoldati A. Ultrasound-guided percutaneous ethanol injection therapy in thyroid cystic nodules. Endocr Pract. 2004;10:269–75.

    PubMed  Google Scholar 

  145. Guglielmi R, Pacella CM, Bianchini A, et al. Percutaneous ethanol injection treatment in benign thyroid lesions: role and efficacy. Thyroid. 2004;14:125–31.

    CAS  PubMed  Google Scholar 

  146. Kim JH, Lee HK, Lee JH, et al. Efficacy of sonographically guided percutaneous ethanol injection for treatment of thyroid cysts versus solid thyroid nodules. Am J Roentgenol. 2003;180:1723–6.

    Google Scholar 

  147. Zingrillo M, Torlontano M, Chiarella R, et al. Percutaneous ethanol injection may be a definitive treatment for symptomatic thyroid cystic nodules not treatable by surgery: five-year follow-up study. Thyroid. 1999;9:763–7.

    CAS  PubMed  Google Scholar 

  148. Bennedbæk FN, Hegedüs L. Treatment of recurrent thyroid cysts with ethanol: a randomized double-blind controlled trial. J Clin Endocrinol Metab. 2003;88:5773–7.

    PubMed  Google Scholar 

  149. Monzani F, Lippi F, Goletti O, et al. Percutaneous aspiration and ethanol scelerotherapy for thyroid cysts. J Clin Endocrinol Metab. 1994;78:800–2.

    CAS  PubMed  Google Scholar 

  150. Monzani F, Goletti O, Caraccio N, et al. Percutaneous ethanol injection treatment of autonomous thyroid adenoma: hormonal and clinical evaluation. Clin Endocrinol (Oxf). 1992;36:491–7.

    CAS  Google Scholar 

  151. Papini E, Panunzi C, Pacella CM, et al. Percutaneous ultrasound-guided ethanol injection: a new treatment of toxic autonomously functioning thyroid nodules? J Clin Endocrinol Metab. 1993;76:411–6.

    CAS  PubMed  Google Scholar 

  152. Livraghi T, Paracchi A, Ferrari C, et al. Treatment of autonomous thyroid nodules with percutaneous ethanol injection: 4-year experience. Radiology. 1994;190:529–33.

    CAS  PubMed  Google Scholar 

  153. Di Lelio A, Rivolta M, Casati M, et al. Treatment of autonomous thyroid nodules: value of percutaneous ethanol injection. Am J Roentgenol. 1995;164:207–13.

    Google Scholar 

  154. Mazzeo S, Toni MG, DeGaudio C, et al. Percutaneous injection of ethanol to treat autonomous thyroid nodules. Am J Roentgenol. 1993;161:871–6.

    CAS  Google Scholar 

  155. Goletti O, Monzani F, Lenziardi M, et al. Cold thyroid nodules: a new application of percutaneous ethanol injection treatment. J Clin Ultrasound. 1994;22:175–8.

    CAS  PubMed  Google Scholar 

  156. Zingrillo M, Collura D, Chiggi MR, et al. Treatment of large cold benign thyroid nodules not eligible for surgery with percutaneous ethanol injection. J Clin Endocrinol Metab. 1998;83:3905–7.

    CAS  PubMed  Google Scholar 

  157. Lyshchik A, Higashi T, Asato R, et al. Thyroid gland tumor diagnosis at US elastography. Radiology. 2005;237:202–11.

    PubMed  Google Scholar 

  158. Rago T, Santini F, Scutari M, et al. Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules. J Clin Endocrinol Metab. 2007;92:2917–22.

    CAS  PubMed  Google Scholar 

  159. Dighe M, Bae U, Richardson ML, et al. Differential diagnosis of thyroid nodules with US elastography using carotid artery pulsation. Radiology. 2008;248:662–9.

    PubMed  Google Scholar 

  160. Rago T, Vitti P. Role of thyroid ultrasound in the diagnostic evaluation of thyroid nodules. Best Pract Res Clin Endocrinol Metab. 2008;22:913–28.

    PubMed  Google Scholar 

  161. Hong Y, Liu X, Li Z, et al. Real-time ultrasound elastography in the differential diagnosis of benign and malignant thyroid nodules. J Ultrasound Med. 2009;28:861–7.

    PubMed  Google Scholar 

  162. Dossing H, Bennedbæk FN, Hegedüs L, et al. Effect of ultrasound-guided interstitial laser photocoagulation on benign solitary solid cold thyroid nodules: one versus three treatments. Thyroid. 2006;16:763–8.

    PubMed  Google Scholar 

  163. Cakir B, Ugras NS, Gul K, et al. Initial report of the results of percutaneous laser ablation of benign cold thyroid nodules: evaluation of histopathological changes after 2 years. Endocr Pathol. 2009;20:170–6.

    PubMed  Google Scholar 

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Braunstein, G.D., Sacks, W. (2012). Thyroid Nodules. In: Braunstein, G. (eds) Thyroid Cancer. Endocrine Updates, vol 32. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-0875-8_3

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