title: Follicular nodules (Thy3) of the thyroid: is total thyroidectomy the best option?
abstract: BACKGROUND
  Identification of the best management strategy for nodules with Thy3 cytology presents particular problems for clinicians. This study investigates the ability of clinical, cytological and sonographic data to predict malignancy in indeterminate nodules with the scope of determining the need for total thyroidectomy in these patients.
  
  
  METHODS
  The study population consisted of 249 cases presenting indeterminate nodules (Thy3): 198 females (79.5%) and 51 males (20.5%) with a mean age of 52.43 ± 13.68 years. All patients underwent total thyroidectomy.
  
  
  RESULTS
  Malignancy was diagnosed in 87/249 patients (34.9%); thyroiditis co-existed in 119/249 cases (47.79%) and was associated with cancer in 40 cases (40/87; 45.98%). Of the sonographic characteristics, only echogenicity and the presence of irregular margins were identified as being statistically significant predictors of malignancy. 52/162 benign lesions (32.1%) and 54/87 malignant were hypoechoic (62.07%); irregular margins were present in 13/162 benign lesions (8.02%), and in 60/87 malignant lesions (68.97%). None of the clinical or cytological features, on the other hand, including age, gender, nodule size, the presence of microcalcifications or type 3 vascularization, were significantly associated with malignancy.
  
  
  CONCLUSIONS
  The rate of malignancy in cytologically indeterminate lesions was high in the present study sample compared to other reported rates, and in a significant number of cases Hashimoto's thyroiditis was also detected. Thus, considering the fact that clinical and cytological features were found to be inaccurate predictors of malignancy, it is our opinion that surgery should always be recommended. Moreover, total thyroidectomy is advisable, being the most suitable procedure in cases of multiple lesions, hyperplastic nodular goiter, or thyroiditis; the high incidence of malignancy and the unreliability of intraoperative frozen section examination also support this preference for total over hemi-thyroidectomy.
authors.affiliation: Department of Surgical Sciences, University of Cagliari, S,S, 554, Bivio Sestu, 09042 Monserrato, (CA), Italy. pgcalo@unica.it.
authors.forename: Pietro Giorgio
authors.initials: PG
authors.lastname: Calò
authors.forename: Fabio
authors.initials: F
authors.lastname: Medas
authors.forename: Rosa
authors.initials: R
authors.lastname: Santa Cruz
authors.forename: Francesco
authors.initials: F
authors.lastname: Podda
authors.forename: Enrico
authors.initials: E
authors.lastname: Erdas
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pisano
authors.forename: Angelo
authors.initials: A
authors.lastname: Nicolosi
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000175:diagnosis / Q000601:surgery; D018249:Adenoma, Oxyphilic; D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000175:diagnosis / Q000601:surgery; D002291:Carcinoma, Papillary; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000601:surgery; D016606:Thyroid Nodule / Q000175:diagnosis / Q000601:surgery*; D013965:Thyroidectomy; D016896:Treatment Outcome