Thyroid nodule surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Surgery
Partially cystic nodules that repeatedly yield nondiagnostic aspirates need close observation or surgical excision. Surgery should be more strongly considered if the cytologically nondiagnostic nodule is solid.
If a cytology result is diagnostic of or suspicious for PTC, surgery is recommended 65
For those patients with subsequent recurrent symptomatic cystic fluid accumulation, surgical removal, generally by hemithyroidectomy, or percutaneous ethanol injection (PEI) are both reasonable strategies
Recurrent cystic thyroid nodules with benign cytology should be considered for surgical removal or PEI based on compressive symptoms and cosmetic concerns.
Bennedbaek FN, Hegedu¨ s L 2003 Treatment of recurrent thyroid cysts with ethanol: a randomized double-blind controlled trial. J Clin Endocrinol Metab 88:5773–5777. 91. Valcavi R, Frasoldati A 2004 Ultrasound-guided percutaneous ethanol injection therapy in thyroid cystic nodules. Endocr Pract 10:269–275
for patients with nodules diagnosed as differentiated thyroid carcinoma (DTC) by FNA during pregnancy, delaying surgery until after delivery does not affect outcome
Moosa M, Mazzaferri EL 1997 Outcome of differentiated thyroid cancer diagnosed in pregnant women. J Clin Endocrinol Metab 82:2862–2866.
A nodule with cytology indicating PTC discovered early in pregnancy should be monitored sonographically and if it grows substantially (as defined above) by 24 weeks gestation, surgery should be performed at that point. However, if it remains stable by midgestation or if it is diagnosed in the second half of pregnancy, surgery may be performed after delivery. In patients with more advanced disease, surgery in the second trimester is reasonable