Presentation of clinically solitary thyroid nodules in surgical patients.
BACKGROUND
Thyroid nodules occupy a unique position in relation to clinical diagnosis since most patients with a thyroid nodule do not present with overt symptoms. There are, however, no good published data demonstrating the way in which clinically solitary thyroid nodules come to medical attention, with most of the literature being anecdotal. This study aims to evaluate the mode of presentation of solitary thyroid nodules, and to assess whether the presence of a malignancy influences that presentation.


METHODS
In this retrospective cohort study, data were obtained from the University of Sydney Endocrine Surgery Database and through a review of the patient records. The study cohort comprised 419 consecutive patients who presented with a clinically solitary thyroid nodule and who subsequently underwent surgery. Patient files lacking data on mode of presentation and patients in whom thyroid nodules were incidentally discovered during parathyroid surgery were excluded, leaving a total of 299 patients. Data were analyzed using a computer-based statistical software package. Continuous variables were compared using Student's t-test. Categorical variables were analyzed using Fishers exact test. Statistical significance was set at p < 0.05.


RESULTS
Solitary thyroid nodules are most commonly detected by the patients themselves (40%), followed by the incidental discovery of nodules on imaging studies performed for unrelated reasons (30%), and lastly due to third-party diagnosis by family, friends, acquaintances, or medical practitioners (30%). Nodules detected by medical practitioners were statistically more likely to be malignant (p = 0.02). No other differences between the clinical presentation of benign and malignant nodules were found.


CONCLUSIONS
Patients themselves are the ones who most commonly first become aware of the thyroid nodules that are eventually seen by thyroid surgeons. Incidental discovery on image studies is also important. Thyroid nodules detected by medical practitioners should be dealt with most urgently because they are most likely to be malignant.
Endocrine Surgical Unit, University of Sydney, Sydney, Australia.
Natasha
N
Mevawalla
Todd
T
McMullen
Stan
S
Sidhu
Mark
M
Sywak
Bruce
B
Robinson
Leigh
L
Delbridge
D000328:Adult; D000368:Aged; D001315:Australia; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000601:surgery; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods