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Clinical investigations from the RACP

Assessment of nodular thyroid disorders

Jim Stockigt

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Abstract

Investigation of patients with thyroid nodules begins clinically and is followed by laboratory assessment of thyroid function. Imaging provides valuable information, but cytology from fine needle aspiration biopsy is the key investigation to determine nodules needing surgical removal.

Key Points

  • Thyroid nodules, single or multiple, palpable or impalpable, are common; thyroid cancer is uncommon and usually not fatal, with a mortality less than 2% of that of breast or lung cancer.
  • Investigation of thyroid nodules begins clinically and is followed by a laboratory assessment of thyroid status.
  • Imaging provides valuable information, but expert cytology from fine needle aspiration biopsy is the key investigation to define which thyroid nodules require surgical removal.
  • The combination of fine needle aspiration biopsy with ultrasound yields better sensitivity and specificity than biopsy guided by palpation alone. Not all nodules require biopsy.
  • Most patients with thyroid nodules require no active treatment.
  • Optimal management of both nodular thyroid disease and thyroid carcinoma requires a multidisciplinary approach, including effective patient education.

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