The clinical importance of thyroid nodules is related to excluding malignancy (4.0 to 6.5% of all thyroid nodules)

​https://sfaki.blogspot.gr/2016/10/thyroid-nodule-update-on-diagnosis-and.html

Table 1

Increased risk of malignancy in thyroid nodule on history and physical exam [1, 3, 13]

- History of childhood head/neck irradiation [113]

- Total body irradiation for bone marrow transplantation [114]

- Exposure to ionizing radiation from fallout in childhood or adolescence [115, 116]

- Family history of PTC, MTC, or thyroid cancer syndrome (e.g., Cowden's syndrome, familial polyposis, Carney complex, multiple endocrine neoplasia [MEN] 2, Werner syndrome) [117]

- Enlarging nodule/rapid nodule growth

- Cervical lymphadenopathy

- Fixed nodule to surrounding tissue

- Vocal cord paralysis/hoarseness

Table 2

Recommendations for diagnostic FNA based on size and US features [1, 35, 36, 37, 85, 86, 118, 119, 120]

A. Nodules ≥ 1 cm with intermediate or high suspicion US pattern

B. Nodules ≥ 1.5 cm with low suspicion US pattern

C. Nodules ≥ 2 cm with very low suspicion US pattern (e.g., spongiform). Observation an alternate option.

D. For nodules that do not meet the above criteria, FNA is not required, including nodules < 1 cm (with some exceptions) and purely cystic nodules.

Alexandros Sfakianakis
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alsfakia@gmail.com