Surgical Indications and Follow-Up of Nodular Goiters – Our Experience

  • Background  
    The objective of this paper is to present the management of nodular goiters, from their clinical discovery to the surgical treatment

    Methods 
    We retrospectively reviewed the medical files of 25 patients treated in our clinic for nodular goiter between 2010 and 2018. 
    The evaluation included:
     – physical examination: rapid growth, irregular shape, hard consistency, fixation to the surrounding tissues, vocal fold paralysis, hoarseness.
    –  laboratory tests: determination of TSH,T3,FT4, anti-thyroglobuline,anti-TPO and TSH receptor antibodies in all cases;
    –  serum calcitonin levels – in 13 cases;
    – ultrasonography – in all patients;
    – fine needle aspiration biopsy (FNAB) for every nodule greater than 1 cm.
    The predictive elements for malignancy were:
    – cervical lymphadenopathy;
    – rapid growth and nodule greater than 3 cm;
    – ultrasonographic data : microcalcifications,neovascularity,infiltrative margins,hypoechogenity.

    Results 
    The histological examinations of the 25 surgically removed specimens found the presence of malignancy in 5 cases (20%).
    The indications for the surgical removal of the nodular goiters were:
    – rapid growing goiters – 2 cases;
    – suspicious features in ultrasonography- 6 cases;
    – positive FNAB – 12 cases;
    – mechanical complications – 2 cases;
    – suspicion of cancer – risk nodules  – 3 cases.
    A histological examination after FNAB was performed in all cases.Results were as follows: sensibility – 92%; specificity – 70% (positive predictive value 39%;negative predictive value 96%). 

    Conclusions 
    Thyroid nodules diagnosed as benign after FNAB require follow-up because of the relatively high false – negative rate. The rapid growth of the nodule is an absolute indication for surgery.

 

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