Indian Journal of Surgical Oncology

, Volume 3, Issue 3, pp 173–181 | Cite as

Thyroid Incidentaloma

  • Seema Singh
  • Anutosh Singh
  • A. K. Khanna
Original Article


Because of emerging investigation modalities many of the thyroid lesions are picked up and that poses a big dilemma about management of such lesions. Majority of these lesions especially in iodine-deficient regions, are not significant and may be only followed up without any active treatment but, sometimes the small lesions may be microcarcinoma. This article discusses about the reliability of clinical examination of neck for detection of such lesions, the controversy of such lesion being benign or malignant, and how to evaluate these lesions and the recommendation as per American Thyroid Association guidelines.


Thyroid Carcinoma Benign Microcarcinoma Guidelines Incidentaloma 


  1. 1.
    Brander A, Viikinkoski P, Tuuhea J, Voutilainen L, Kivisaari L (1992) Clinical versus ultrasound examination of the thyroid gland in common clinical practice. J Clin Ultrasound 20:37–42PubMedCrossRefGoogle Scholar
  2. 2.
    Cook DM, Loriaux DL (1996) The incidental adrenal mass. Am J Med 101:88–94PubMedCrossRefGoogle Scholar
  3. 3.
    Thyroid Incidentaloma. Hot Thyroidology. http// Scholar
  4. 4.
    Boehm T, Rothouse L, Wartofsky L (1976) Metastatic occult follicular thyroid carcinoma. JAMA 235:2420–2421PubMedCrossRefGoogle Scholar
  5. 5.
    Vander JB, Gaston EA, Dawber TR (1968) The significance of non-toxic thyroid nodules. Final report of a 15-year study of the incidence of thyroid malignancy. Ann Int Med 69:537–540PubMedGoogle Scholar
  6. 6.
    Belfiore A, La Rosa GL, La Porta GA et al (1992) Cancer risk in patients with cold thyroid nodules; relevance of iodine intake, sex, age, and multinodularity. Am J Med 93:363–369PubMedCrossRefGoogle Scholar
  7. 7.
    Rojeski MT, Gharib H (1985) Nodular thyroid disease. Evaluation and management. N Engl J Med 313:428–436PubMedCrossRefGoogle Scholar
  8. 8.
    Sampson RJ, Woolner LB, Bahn RC, Kurland LT (1974) Occult thyroid carcinoma in Olmsted County, Minnesota: prevalence at autopsy compared with that in Hiroshima and Nagasaki, Japan. Cancer 34:2072–2076PubMedCrossRefGoogle Scholar
  9. 9.
    Bondeson L, Ljungberg O (1981) Occult thyroid carcinoma at autopsy in Malmo, Sweden. Cancer 47:319–323PubMedCrossRefGoogle Scholar
  10. 10.
    Fukunaga FH, Yatani R (1975) Geographic pathology of occult thyroid carcinomas. Cancer 36:1095–1099PubMedCrossRefGoogle Scholar
  11. 11.
    Hanson GA, Komorowski RA, Cerletty JM, Wilson SD (1983) Thyroid gland morphology in young adults: normal subjects versus those with prior low-dose neck irradiation in childhood. Surgery 94:984–988PubMedGoogle Scholar
  12. 12.
    Wagner DH, Recant WM, Evans RH (1978) A review of one hundred and fifty thyroidectomies following prior irradiation to the head, neck and upper part of the chest. Surg Gynecol Obstet 147:903–908PubMedGoogle Scholar
  13. 13.
    Mazzaferri EL (1993) Management of a solitary thyroid nodule. N Engl J Med 328:553–559PubMedCrossRefGoogle Scholar
  14. 14.
    Kasper DL, Braunwald E, Fauci AS (2005) Harrison’s principles of internal medicine. McGraw-Hill, New York, pp 2104–2127Google Scholar
  15. 15.
    Siminoski K (1995) Does this patient have a goiter? JAMA 273:813–817PubMedCrossRefGoogle Scholar
  16. 16.
    Tan GH, Gharib H, Reading CC (1995) Solitary thyroid nodule. Comparison between palpation and ultrasonography. Arch Intern Med 155:2418–2423PubMedCrossRefGoogle Scholar
  17. 17.
    Christensen SB, Tibblin S (1985) The reliability of the clinical examination of the thyroid gland. A prospective study of 100 consecutive patients surgically treated for hyperparathyroidism. Ann Chir Gynaecol 74:151–154PubMedGoogle Scholar
  18. 18.
    McHenry C, Smith M, Lawrence AM, Jarosz H, Paloyan E (1988) Nodular thyroid disease in children and adolescents: a high incidence of carcinoma. Am Surg 54:444–447PubMedGoogle Scholar
  19. 19.
    Psarras A, Papadopoulos SN, Livadas D, Pharmakiotis AD, Koutras DA (1972) The single thyroid nodule. Br J Surg 59:545–548PubMedCrossRefGoogle Scholar
  20. 20.
    Belfiore A, La Rosa GL, Padova G, Sava L, Ippolito O, Vigneri R (1987) The frequency of cold thyroid nodules and thyroid malignancies in patients from an iodine-deficient area. Cancer 60:3096–3102PubMedCrossRefGoogle Scholar
  21. 21.
    Hamming JF, Goslings BM, van Steenis GJ, van Ravenswaay CH, Hermans J, van de Velde CJH (1990) The value of fine-needle aspiration biopsy in patients with nodular thyroid disease divided into groups of suspicion of malignant neoplasms on clinical grounds. Arch Intern Med 150:113–116PubMedCrossRefGoogle Scholar
  22. 22.
    Mortensen JD, Woolner LB, Bennett WA (1955) Gross and microscopic findings in clinically normal thyroid glands. J Clin Endocrinol Metab 15:1270–1280PubMedCrossRefGoogle Scholar
  23. 23.
    Komorowski RA, Hanson GA (1988) Occult thyroid pathology in the young adult: an autopsy study of 138 patients without clinical thyroid disease. Hum Pathol 19:689–696PubMedCrossRefGoogle Scholar
  24. 24.
    Horlocker TT, Hay JE, James EM, Reading CC, Charboneau JW (1985) Prevalence of incidental nodular thyroid disease detected during high-resolution parathyroid ultrasonography. In: Medeiros-Neto G, Gaitan E (eds) Frontiers in thyroidology. Plenum Medical, New York, pp 1309–1312Google Scholar
  25. 25.
    Brander A, Viikinkoski P, Nickels J, Kivisaari L (1991) Thyroid gland: US screening in a random adult population. Radiology 181:683–687PubMedGoogle Scholar
  26. 26.
    Pacini F, Vorontsova T, Demidchik E, Molinaro E, Agate L, Romei C, Shavrova E, Cherstvoy ED, Ivashkevitch Y, Kuchinskaya E, Schlumberger M, Ronga G, Filesi M, Pinchera A (1997) Post-Chernobyl thyroid carcinoma in Belarus children and adolescents: comparison with naturally occurring thyroid carcinoma in Italy and France. J Clin Endocrinol Metab 81:3563–3569CrossRefGoogle Scholar
  27. 27.
    Boelaert K, Horacek J, Holder RL, Watkinson JC, Sheppard MC, Franklyn JA (2006) Serum thyrotropin concentration as a novel predictor of malignancy in thyroid nodules investigated by fine-needle aspiration. J Clin End Metab 91:4295–4301CrossRefGoogle Scholar
  28. 28.
    Pacini F, Pinchera A, Giani C, Grasso L, Baschieri L (1980) Serum thyroglobulin in thyroid carcinoma and other thyroid disorders. Clin Endocrinol 13:107–110CrossRefGoogle Scholar
  29. 29.
    Costante G, Meringolo D, Durante C, Bianchi D, Nocera M, Tumino S, Crocetti U, Attard M, Maranghi M, Torlontano M, Filetti S (2007) 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 92:450–455PubMedCrossRefGoogle Scholar
  30. 30.
    Cheung K, Roman SA, Wang TS, Walker HD, Sosa JA (2008) Calcitonin measurement in the evaluation of thyroid nodules in the United States: a cost-effectiveness and decision analysis. J Clin Endocrinol Metab 93:2173–2180PubMedCrossRefGoogle Scholar
  31. 31.
    Gagel RF, Hoff AO, Cote GJ (2005) Medullary thyroid carcinoma. In Werner and Ingbar’s The Thyroid. Lippincott Williams and Wilkins, Philadelphia, pp 967–988Google Scholar
  32. 32.
    Danese D, Sciacchitano S, Farsetti A, Andreoli M, Pontecorvi A (1998) Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid 8:15–21PubMedCrossRefGoogle Scholar
  33. 33.
    Alexander EK, Heering JP, Benson CB, Frates MC, Doubilet PM, Cibas ES, Marqusee E (2002) Assessment of nondiagnostic ultrasound-guided fine needle aspiration of thyroid nodules. J Clin Endocrinol Metab 87:4924–4927PubMedCrossRefGoogle Scholar
  34. 34.
    Baloch ZW, LiVolsi VA, Asa SL, Rosai J, Merino MJ, Randolph G, Vielh P, DeMay RM, Sidawy MK, Frable WJ (2008) Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagn Cytopathol 36:425–437PubMedCrossRefGoogle Scholar
  35. 35.
    Noguchi S, Yamashita H, Uchino S, Watanabe S (2008) Papillary microcarcinoma. World J Surg 32:747–753PubMedCrossRefGoogle Scholar
  36. 36.
    Wada N, Duh QY, Sugino K, Iwasaki H, Kameyama K, Mimura T, Ito K, Takami H, Takanashi Y (2003) Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg 237:399–407PubMedGoogle Scholar
  37. 37.
    Hemminki K, Eng C, Chen B (2005) Familial risks for nonmedullary thyroid cancer. J Clin Endocrinol Metab 90:5747–5753PubMedCrossRefGoogle Scholar
  38. 38.
    Schneider AB, Ron E, Lubin J, Stovall M, Gierlowski TC (1993) Dose-response relationships for radiation-induced thyroid cancer and thyroid nodules: evidence for the prolonged effects of radiation on the thyroid. J Clin Endocrinol Metab 77:362–369PubMedCrossRefGoogle Scholar
  39. 39.
    Shibata Y, Yamashita S, Masyakin VB, Panasyuk GD, Nagataki S (2001) 15 years after Chernobyl: new evidence of thyroid cancer. Lancet 358:1965–1966PubMedCrossRefGoogle Scholar
  40. 40.
    Leenhardt L, Hejblum G, Franc B, Fediaevsky LD, Delbot T, Le Guillouzic D, Me’ne’gaux F, Guillausseau C, Hoang C, Turpin G, Aurengo A (1999) Indications and limits of ultrasound-guided cytology in the management of nonpalpable thyroid nodules. J Clin Endocrinol Metab 84:24–28PubMedCrossRefGoogle Scholar
  41. 41.
    Jeh SK, Jung SL, Kim BS, Lee YS (2007) Evaluating the degree of conformity of papillary carcinoma and follicular carcinoma to the reported ultrasonographic findings of malignant thyroid tumor. Korean J Radiol 8:192–197PubMedCrossRefGoogle Scholar
  42. 42.
    Machens A, Holzhausen HJ, Dralle H (2005) The prognostic value of primary tumor size in papillary and follicular thyroid carcinoma. Cancer 103:2269–2273PubMedCrossRefGoogle Scholar
  43. 43.
    Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, Orcutt J, Moore FD Jr, Larsen PR, Marqusee E, Alexander EK (2006) Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clin Endocrinol Metab 91:3411–3417PubMedCrossRefGoogle Scholar
  44. 44.
    Bonavita JA, Mayo J, Babb J, Bennett G, Oweity T, Macari M, Yee J (2009) Pattern recognition of benign nodules at ultrasound of the thyroid: which nodules can be left alone? AJR Am J Roentgenol 193:207–213PubMedCrossRefGoogle Scholar
  45. 45.
    Rago T, Santini F, Scutari M, Pinchera A, Vitti P (2007) Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules. J Clin Endocrinol Metab 92:2917–2922PubMedCrossRefGoogle Scholar
  46. 46.
    Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Sherman SI, Tuttle RM (2009) The American Thyroid Association Guidelines Taskforce. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16:1167–1176CrossRefGoogle Scholar
  47. 47.
    Delbeke D (1999) Oncological applications of FDG PET imaging: brain tumors, colorectal cancer, lymphoma and melanoma. J Nucl Med 40:591–603PubMedGoogle Scholar
  48. 48.
    Chen YK, Ding HJ, Chen KT et al (2005) Prevalence and risk of cancer of focal thyroid incidentaloma identified by 18 F-fluorodeoxyglucose positron emission tomography for cancer screening in healthy subjects. Anticancer Res 25:1421–1426PubMedGoogle Scholar
  49. 49.
    Cohen MS, Arslan N, Dehdashti F et al (2001) Risk of malignancy in thyroid incidentalomas identified by fluorodeoxyglucose—positron emission tomography. Surgery 130:941–946PubMedCrossRefGoogle Scholar
  50. 50.
    Kim TY, Kim WB, Ryu JS, Gong G, Hong SJ, Shong YK (2005) 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 115:1074–1078PubMedCrossRefGoogle Scholar
  51. 51.
    Mitchell JC, Grant F, Evenson AR, Parker JA, Hasselgren PO, Parangi S (2005) Preoperative evaluation of thyroid nodules with 18FDG-PET/CT. Surgery 138:1166–1174, discussion 1174–1175PubMedCrossRefGoogle Scholar
  52. 52.
    Gordon BA, Flanagan FL, Dehdashti F (1997) Wholebody positron emission tomography: normal variations, pitfalls, and technical considerations. AJR 169:1675–1680PubMedGoogle Scholar
  53. 53.
    Rallison ML, Dobyns BM, Keating FR Jr, Rall JE, Tyler FH (1975) Thyroid nodularity in children. JAMA 233:1069–1072PubMedCrossRefGoogle Scholar
  54. 54.
    Corrias A, Einaudi S, Chiorboli E, Weber G, Crino A, Andreo M, Cesaretti G, de Sanctis L, Messina MF, Segni M, Cicchetti M, Vigone M, Pasquino AM, Spera S, de Luca F, Mussa GC, Bona G (2001) Accuracy of fine needle aspiration biopsy of thyroid nodules in detecting malignancy in childhood: comparison with conventional clinical, laboratory, and imaging approaches. J Clin Endocrinol Metab 86:4644–4648PubMedCrossRefGoogle Scholar
  55. 55.
    Tan GH, Gharib H, Goellner JR, van Heerden JA, Bahn RS (1996) Management of thyroid nodules in pregnancy. Arch Intern Med 156:2317–2320PubMedCrossRefGoogle Scholar
  56. 56.
    Moosa M, Mazzaferri EL (1997) Outcome of differentiated thyroid cancer diagnosed in pregnant women. J Clin Endocrinol Metab 82:2862–2866PubMedCrossRefGoogle Scholar
  57. 57.
    Mestman JH, Goodwin TM, Montoro MM (1995) Thyroid disorders of pregnancy. Endocrinol Metab Clin North Am 24:41–71PubMedGoogle Scholar
  58. 58.
    Kuy S, Roman SA, Desai R, Sosa JA (2009) Outcomes following thyroid and parathyroid surgery in pregnant women. Arch Surg 144:399–406PubMedCrossRefGoogle Scholar
  59. 59.
    Rosen IB, Korman M, Walfish PG (1997) Thyroid nodular disease in pregnancy: current diagnosis and management. Clin Obstet Gynecol 40:81–89PubMedCrossRefGoogle Scholar
  60. 60.
    Singer PA, Cooper DS, Daniels GH, Ladenson PW, Greenspan FS, Levy EG, Braverman LE, Clark OH, McDougall IR, Ain KV, Dorfman SG (1996) Treatment guidelines for patients with thyroid nodules and well-differentiated thyroid cancer. American Thyroid Association. Arch Intern Med 156:2165–2172PubMedCrossRefGoogle Scholar
  61. 61.
    Kuma K, Matsuzuka F, Yokozawa T, Miyauchi A, Sugawara M (1994) Fate of untreated benign thyroid nodules: results of long-term follow-up. World J Surg 18:495–498PubMedCrossRefGoogle Scholar
  62. 62.
    Carmeci C, Jeffrey RB, McDougall IR, Nowels KW, Weigel RJ (1998) Ultrasound-guided fine-needle aspiration biopsy of thyroid masses. Thyroid 8:283–289PubMedCrossRefGoogle Scholar
  63. 63.
    McCoy KL, Jabbour N, Ogilvie JB, Ohori NP, Carty SE, Yim JH (2007) The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size. Surgery 142:837–844PubMedCrossRefGoogle Scholar
  64. 64.
    Alexander EK, Hurwitz S, Heering JP, Benson CB, Frates MC, Doubilet PM, Cibas ES, Larsen PR, Marqusee E (2003) Natural history of benign solid and cystic thyroid nodules. Ann Int Med 138:315–318PubMedGoogle Scholar
  65. 65.
    Asanuma K, Kobayashi S, Shingu K, Hama Y, Yokoyama S, Fujimori M, Amano J (2001) The rate of tumour growth does not distinguish between malignant and benign thyroid nodules. Eur J Surg 167:102–105PubMedCrossRefGoogle Scholar
  66. 66.
    Brauer VF, Eder P, Miehle K, Wiesner TD, Hasenclever H, Paschke R (2005) Interobserver variation for ultrasound determination of thyroid nodule volumes. Thyroid 15:1169–1175PubMedCrossRefGoogle Scholar
  67. 67.
    Oertel YC, Miyahara-Felipe L, Mendoza MG, Yu K (2007) Value of repeated fine needle aspirations of the thyroid: an analysis of over ten thousand FNAs. Thyroid 17:1061–1066PubMedCrossRefGoogle Scholar

Copyright information

© Indian Association of Surgical Oncology 2011

Authors and Affiliations

  1. 1.Department of General Surgery, Institute of Medical SciencesBanaras Hindu UniversityVaranasiIndia

Personalised recommendations