DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20173033

Solitary nodule thyroid: diagnosis and management

M. Deepthi, P. S. Sukthankar, K. Narsimloo

Abstract


Background: Solitary nodule can be a true solitary nodule or a dominant nodule of multinodular goitre or ectopic thyroid or unilateral agenesis. Solitary nodule can be benign or malignant. Purpose of evaluation is to differentiate between the two.

Methods: A prospective study of solitary nodule thyroid (STN) patients presenting to ENT outpatient department, for a period of 3 years from September 2012 to 2015.  

Results: Out of 67 patients enrolled into study, 53 patients had benign true STN, 9 patients had multinodular goiter (MNG) presenting as solitary nodule and 5 had malignant nodule (7.46%). Among the benign nodules, 25 patients had small solitary nodule (<4 cm size). They were treated medically and followed-up for a period of 1 year. 28 patients with large benign solitary nodules (>4 cm size) were taken up for surgery directly. Hemithyroidectomy was done in benign STN patients (39 patients) and total thyroidectomy was done in malignant nodule and MNG patients and followed-up by lifelong L-T4 therapy.

Conclusions: Small benign solitary nodules regress with medical therapy alone. In large solitary nodules, and in those nodules not regressing with medical therapy, hemithyroidectomy is adequate. In MNG and malignant nodules, total thyroidectomy is advocated. Hemithyroidectomy and total thyroidectomy patients were followed - up with suppression and supplementation therapy respectively.This area being fluorotic belt, there is an increased prevalence of goiter. This study gives a concise guideline in evaluation and management of STN for goiter endemic areas.

 


Keywords


Solitary nodule, Thyroid nodule, Dominant nodule

Full Text:

PDF

References


Walsh RM, Watkinson JC, Franklyn J. The management of the solitary thyroid nodule: a review. Clin Otolaryngol. 1999;24:388-97.

NS Neki, HL Kazal. Solitary Thyroid Nodule – An Insight. JIACM. 2006;7(4):328-33.

Sengupta A, Pal R, Kar S, Zaman FA, Basu M, Pal S. Clinico- pathological correlates of incidentally revealed thyroid swelling in Bihar, India. J Pharm Bioall Sci. 2012;4:51-5.

Kelley DJ. Evaluation of Solitary Thyroid Nodule. Available at: http://emedicine.medscape.com/ article/850823-overview#a1 Accessed on 3 March 2017.

Kendall LW, Condon RE. Prediction of Malignancy in Solitary thyroid Nodules. Lancet. 1969;293(7605):1071-3.

Hamburger JI, Husain M, Nishiyama R, Nunez C and Solomon D. Increasing the accuracy of fineneedle biopsy for thyroid nodules. Arch Pathol Lab Med. 1989;113:1035-41.

Hundahl SA, Cady B, Cunningham MP, Mazzaferri E, McKee RF, Rosai J, et al. Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the united states during 1996. U.S. and German Thyroid Cancer Study Group. An American College of Surgeons Commission on Cancer Patient Care Evaluation study. Cancer. 2000;89(1):202-17.

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

Leenhardt L, Hejblum G, Franc B, Fediaevsky LD, Delbot T, Le Guillouzic D, et al. Indications and limits of ultrasound-guided cytology in the management of nonpalpable thyroid nodules. J Clin Endocrinol Metab. 1999;84:24-8.

Hegedüs L, Bonnema SJ, Bennedbaek FN. Management of Simple Nodular Goiter: Current status and Future Perspectives. Endocr Rev. 2003;24(1):102-32.

Berghout A, Wiersinga WM, Smits NJ, Touber JL Interrelationships between age, thyroid volume, thyroid nodularity, and thyroid function in patients with sporadic nontoxic goiter. Am J Med. 1990;89(5):602-8.