Follow-Up of Large Thyroid Nodules without Surgery: Patient Selection, and Long Term Outcomes

  • Background: The management of large thyroid nodules remains controversial. Mandatory resection is recommended by some authors.

    Purpose: The aim of the study was to assess the management and outcome of large thyroid nodules using a risk stratification strategy rather than mandatory / diagnostic resections approach.

    Methods: All patients with thyroid nodules ?30 mm who underwent ultrasound-guided FNA thyroid biopsies between 1/2009 – 1/2013 were followed until August 1st 2017. Follow-up data was collected using an integrated hospital-community system, which includes all patient imaging, doctors’ visits and biopsies held in or outside our institution. Collected data included demographics, sonographic descriptions, cytology and histology when available.

    Results: 141 nodules were included. Of these, 37/141 (26%) nodules were initially referred to surgery, resulting in a 32% malignancy rate (12/37). The remaining 104/141 (74%) were referred to follow-up. During the follow-up period, 24 additional operations were done, resulting in a 4% malignancy rate (1/24). An indication of non–benign cytology was significantly associated with malignancy compared with other indications. The median follow-up of nodules which were clinically followed was 53.5 months (IQR 33.8-67.4). None of the patients developed regional or distal diseases during follow-up. The mean change in nodule size during the follow-up period was a 7% reduction, with no significant trend of change over time.

    Conclusion: Careful patient selection based on clinical, sonographic and cytologic features can reduce diagnostic surgery allowing for safe follow-up of large thyroid nodules without surgery.  


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