Abstract:
BACKGROUND : The work-up of a thyroid nodule to diagnose malignancy is not always straightforward. There are various
international thyroid societies each with their own guidelines on the approach to a thyroid nodule. The aim is therefore to determine
whether a clinically suspicious thyroid nodule should be subjected to surgery.
METHOD : A review of various international thyroid society guidelines on their approach to a suspicious thyroid nodule.
RESULTS : Sixty-two relevant articles were identified of which 4 current international thyroid guidelines, consisting of 6 different
international societies, were reviewed. The commonalities of each of the thyroid society guidelines are imaging, with ultrasound, and
cytopathology as the main diagnostic investigations. The description and the size of the nodule are the 2 most important factors on
ultrasound; however, the guidelines vary in their recommendations whether to biopsy a suspicious thyroid nodule. An indeterminate
group exists whereby thyroid nodules cannot be confirmed as malignant even with fine needle aspiration cytology (FNA). Although
further investigations (Technetium-99m -sestamethoxyisobutylisonitryl scan, 18F-fluorodeoxyglucose positron emission tomography/
computed tomography scan, and molecular testing) may assist in the diagnosis, there are limitations. There are differences in the
guidelines whether suspicious nodules should be subjected to surgery.
CONCLUSION : Ultrasound and cytopathology are the 2 most appropriate investigations to diagnose whether a suspicious thyroid
nodule is benign or malignant. The clinician needs to be aware of the differences between the guidelines from the various international
thyroid societies, specifically concerning the indeterminate group of patients where a definitive diagnosis cannot be made.
Management decisions should be discussed with a thyroid multidisciplinary team for a consensus decision whether or not to subject
a patient with a suspicious thyroid nodule to surgery.
