ABSTRACT
Nodular thyroid disease refers to the presence of a solitary solid nodule, a multinodular gland, or one or more cystic lesions. The evolution of new concepts and technological advancements has had considerable impact on the management of nodular thyroid disease over the past decade. These include:
Recognition of an increased prevalence of nodular thyroid disease and an increased potential for thyroid carcinoma in nodules traditionally thought to be at low risk (multinodular goiter, cystic, chronic, and those nodules associated with hyperthyroidism)
Low lethality of papillary thyroid cancer, the most common type of thyroid cancer, based on longterm clinical data
Popularization of office-based ultrasonography (US) and ultrasound-guided fine needle aspiration biopsy (UG-FNA)
Development of highly sensitive thyroid-stimulating hormone (TSH) assays
Demonstration of low sensitivity and specificity of L-thyroxine suppression therapy to differentiate benign from malignant nodules
Use of minimally invasive thyroid surgical techniques
New thyroid nodules appear at an annual rate of 0.08% (1). There is a 5-10% lifetime risk for palpable
nodular thyroid disease, which is increased in iodine deficient areas and decreased in iodine-sufficient areas (2). Also, 20-40% of patients with normal thyroid glands on palpation will have clinically significant ultrasound-demonstrable thyroid nodules (3,4) or additional nonpalpable nodules in a patient with a single palpable nodule (5). Furthermore, 50% of patients with thyroid glands that are normal by palpation will have small, subcentimetric nodules (6).
