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Head Neck. 2018 Aug;40(8):1861-1873. doi: 10.1002/hed.25160. Epub 2018 Apr 1.

Investigation of thyroid nodules: A practical algorithm and review of guidelines.

Author information

1
Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
2
Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
3
Department of Radiology, Jewish General Hospital and McGill University, Montreal, Quebec, Canada.
4
Department of General Surgery, University of Toronto, Toronto, Ontario, Canada.
5
Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut.

Abstract

BACKGROUND:

High resolution ultrasound has led to early detection of subclinical tumors and drastic increase in incidence of thyroid malignancy. To achieve a balance in appropriate investigation without perpetuating an overdiagnosis phenomenon, a concise set of evidence-based recommendations to stratify risk is required.

METHODS:

We sought to assemble an evidence-based diagnostic algorithm and accompanying pictorial review for workup of thyroid nodules that summarizes the most recent guidelines. In addition, we conducted a literature search and analysis of our imaging databases.

RESULTS:

Although many imaging features of benign and malignant nodules can be nonspecific, others, such as microcalcifications, lymphadenopathy, and peripheral invasion, are highly suggestive of malignancy. The predictive values of salient imaging characteristics are presented.

CONCLUSION:

Evidence-based guidelines are available such that a cost-effective algorithm for thyroid nodule workup can be devised. Conservative management with a focus on periodic monitoring is the working clinical consensus on the approach to thyroid nodules.

KEYWORDS:

fine-needle aspiration (FNA) biopsy; imaging features; thyroid nodule; ultrasound; well differentiated thyroid carcinoma

PMID:
29607563
DOI:
10.1002/hed.25160

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