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Thyroid. 2017 Nov;27(11):1378-1384. doi: 10.1089/thy.2017.0201. Epub 2017 Sep 14.

Temporal Changes in Thyroid Nodule Volume: Lack of Effect on Paranodular Thyroid Tissue Volume.

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1 Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma Sapienza , Rome, Italy .
2 Unità di Endocrinologia , Ospedale di Tinchi-Pisticci, Matera, Italy .
3 Center for Outcomes Research and Clinical Epidemiology , Pescara, Italy .
4 Dipartimento di Scienze della Salute, Università di Catanzaro Magna Graecia , Catanzaro, Italy .
5 Department of Internal Medicine, Institut Jules Bordet Comprehensive Cancer Center , Brussels, Belgium .
6 Unità Operativa Semplice Dipartimentale di Endocrinologia , Ospedale di Bentivoglio, Bologna, Italy .
7 Dipartimento di Medicina, Università di Perugia , Perugia, Italy .
8 Unità Operativa di Endocrinologia, Istituto di Ricovero e Cura a Carattere Scientifico , Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy .
9 Dipartimento di Scienze Mediche e Pediatriche, Università di Catania , Catania, Italy .
10 Unità Operativa di Endocrinologia , Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy .
11 Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine , Baltimore, Maryland.



The term "nodular goiter" has long been used to refer to a nodular thyroid gland, based on the assumption that nodule growth may be associated with hyperplasia of the surrounding non-nodular tissue. The aim of this prospective, multicenter, observational study was to determine whether nodule growth is accompanied by growth in the non-nodular tissue.


Eight Italian thyroid-disease referral centers enrolled 992 consecutive patients with one to four benign nodules. Nodular and non-nodular thyroid tissue volumes were assessed for five years with annual ultrasound examinations.


In participants whose nodules remained stable (n = 839), thyroid volumes did not change (baseline 15.0 mL [confidence interval (CI) 14.5-15.6]; five-year evaluation 15.1 mL [CI 14.5-15.7]). In participants with significant growth of one or more nodule (n = 153), thyroid volumes increased and by year 5 were significantly greater than those of the former group (17.4 mL [CI 16-18.7]). In 76 individuals with unilateral nodules that grew, the mean nodular lobe volume significantly exceeded that of the contralateral lobe (8.6 mL [CI 7.4-9.8] vs. 6.7 mL [CI 6-7.4]). The unaffected lobe volumes remained stable over time, while nodular lobes grew steadily and were significantly greater at the end of follow-up (10.1 mL [CI 8.9-11.3]). Excluding the volume of the largest growing nodule in these cases, the remaining volume of the affected lobe remained virtually unchanged with respect to its baseline value. Furthermore, there was no significant difference in the non-nodular tissue volume between the unaffected lobe and the affected lobe (with the largest growing nodule volume subtracted), both at baseline and at the end of follow-up.


The growth of thyroid nodules is a local process, not associated with growth of the surrounding non-nodular tissue. Therefore, a normal-sized thyroid containing nodules should be referred to as a "uni- or multinodular thyroid gland" and considered a distinct entity from "uni- or multinodular goiter."


goiter; neck ultrasound; nodular goiter; thyroid gland; volume

[Indexed for MEDLINE]

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