What is the best method of long-term followup of patients with thyroid nodules?
Fine needle aspiration is the method of choice for evaluating thyroid lesions. However, it is not a perfect test. FNAs have a well-documented false-negative rate of approximately five percent. The false-negative rate is higher in those FNA cases performed with palpation (one percent to three percent) compared with those done under ultrasound guidance (0.6 percent). This is the basis for recommending followup even in nodules diagnosed as benign. Clinically significant nodular growth, preferably documented by serial ultrasounds (defined as 20 percent increase in diameter), is an indication for repeat aspiration.
Noticeably palpable benign nodules should undergo clinical followup at six- to 18-month intervals and do not require sonographic monitoring. All other benign nodules should be followed with serial ultrasounds at six- to 18-month intervals. Any clinical or sonographic evidence of nodular growth should generate a sonographically guided FNA.
What is the management of thyroid nodules in children?
Thyroid nodules are less prevalent in children than in adults, occurring in approximately 20 per 1,000 children. However, some studies show a higher rate of malignancy in children than in adults (15 percent to 20 percent). FNA biopsy is an accurate diagnostic method for childhood thyroid nodules. The diagnostic and therapeutic approach to one or more thyroid nodules in a child should be the same as in an adult.
What is the management of thyroid nodules in pregnant women?
Evaluation during pregnancy is the same as for a patient who is not pregnant except that a radionuclide scan is contraindicated. If the FNA is malignant, surgery should be considered before 24 weeks of gestation to minimize the risk of miscarriage.
Studies have shown that thyroid cancers in pregnant women have a similar biologic behavior to those diagnosed in a similar-aged group of non-pregnant women. There appears to be no difference in recurrence or survival rates between women operated on during or after pregnancy. In addition, there is evidence that treatment delays of less than one year do not adversely affect patient outcome. Therefore, it is wise to wait until after delivery for definitive surgery if the nodule remains stable by midgestation or if it is diagnosed in the second half of pregnancy.