Thyroid Nodules in 2017: A Year of Big Changes in How to Treat Thyroid Nodules
The presence of a thyroid nodule causes great concern to the patient. That is why the finding of thyroid nodules with high powered imaging like ultrasound and CT/MR causes the finding of too many small nodules that end up being biopsied.How does the patient protect themselves from this stressful situation? First demand a clinical important reason for the need for these studies especially thyroid ultrasound. Do not allow screening or routine thyroid ultrasound or CT/MRs.If you do end up with a image study showing a nodule, do not panic as 95% are not cancer, and use the same criteria for the need for biopsy as you did for the ultrasound. Small nodules without risk features DO NOT NEED biopsy.Larger spongioform nodules are not cancer and don’t need biopsy.If you have allowed a biopsy out of fear of cancer do not have surgery until the nodule diagnosis is evaluated by second opinion.THis could include a re-biopsy by an expert thyroidologist and the addition of molecular markers such as BRAF and a benign classifier. This is the big change from the past methods. Small nodules (1 cm) suspicious or cancer can be treated by Active surveillance instead of surgery and radiation without a risk to you. Finally, there are cancers there were called follicular variant of papillary cancer that have been decided by experts to be benign and are not cancers at all, and don’t need anything more routine follow up or a simple lobe removal at the most. They may not need thyroid hormone therapy either. The presence of large goiter nodules can be the cause of patient’s neck symptoms, and can be a cosmetic problem. Surgery was the only answer until 10-15 years ago.The use of ethanol ablation PEI has proven safe an effective to replace surgery as the first line treatment for thyroid and parathyroid cystic disease. Surgery is also not the first choice anymore for solid benign thyroid nodules. Radiofrequency ablation (RFA) is able to shrink nodules relieve symptoms and cosmetic concerns without hospitalization and major surgery.
Thyroid nodules that don’t not need biopsy. Spongy small cystic spaces indicate a benign nodule.