Surgical management of the thyroid nodules.
The evaluation and the management of thyroid nodules have evolved during the last years. Before the 1980's the strategy was relatively simple, the palpable thyroid nodules were explored by scintigraphy, a method that separated the "hot" nodules (with a low possibility of being cancer) from the "cold" nodules (that included most types of cancer). During the last 25 years, the development of new techniques such as HRUS( high resolution ultrasonography) and HRUS-guided FNAB (fine-needle aspiration biopsy) slowly replaced the 'traditional' methods. As a consequence, the management of the thyroid nodules has become more and more complex but with greater expenses. The objective of this paper is to evaluate the thyroid nodules and their management. We retrospectively reviewed the medical charts of 40 patients managed at our departments for thyroid nodules over a 5-year period (january 2004-december 2008). The evaluation of every patient included physical examination, serum TSH, T3 and T4 levels in some cases serum calcitonin levels, cervical ultrasonography--HRUS or cervical color Doppler ultrasonography, HRUS-guided FNAB, using surgical specimen histology as the reference. The histological examination of the surgically-removed thyroid nodules found the evidence of malignancy in 7 cases with a rate of cancer of 17.5% in the studied population. Age older than 70 years, a hard nodule upon palpation, hypoechogenicity and micro-calcifications significantly predicted cancer. This study highlights the fact that apart from the histological examination of the surgical specimen, HRUS and HRUS-guided FNAB are the best diagnostic tools for differentiating benign thyroid nodules from suspicious or malignant nodules.
Codreanu
C
C
Galaţi County Hospital, ENT Department, Galaţi, Romania.
Codreanu
C M
CM
D000328:Adult; D000465:Algorithms; D044963:Biopsy, Fine-Needle; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000601:surgery; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional