2 articles
Thyroid nodules are a common condition in medical practice, and the correct selection of patients for surgical treatment is essential in their management. Thyroidectomy is indicated with predilection for nodules suspected of being malignant, with progressive growth or with compressive symptoms.
The study included 89 patients diagnosed with unilateral or bilateral thyroid nodules who met the indications for surgical treatment. All patients underwent preoperative evaluation, including clinical examination, standard laboratory tests, thyroid ultrasonography, hormonal profiling, and fine-needle aspiration in cases with a high suspicion of malignancy.
Out of the total number of patients, 2 (2.25%) patients had contraindications to surgery due to cardiac comorbidities associated with high anesthetic-surgical risk. Total thyroidectomy was performed in 41 patients (46.09%), hemithyroidectomy in 44 patients (49.41%), and combined surgeries in 2 cases (2.25%). Postoperative outcomes were favorable in all patients, with no complications registered during the follow-up period. Hormone replacement therapy was administered based on postoperative thyroid hormone levels. Patients who did not undergo surgery were followed up regularly.
The extent of thyroidectomy should be tailored to each patient based on the estimated risk of malignancy and the clinical-imaging features of nodules. Total thyroidectomy is recommended in cases with suspected malignancy or bilateral disease, whereas lobectomy may be sufficient for unilateral benign nodules or low malignancy risk.
The widespread use of diagnostic imaging favored the increasing incidence of thyroid nodules. Although most of nodules are benign, their clinical importance lies in the need to exclude malignancy. In assessing and managing thyroid nodules may occur the phenomenon of overdiagnosis and overtreatment on one hand and the risk of missing an aggressive thyroid cancer on the other hand. The equilibrium that has to be reached by health care providers.
We conducted a PubMed, MEDLINE, ISI Web of Science, Cochrane databases search for the relevant and recent guidelines, meta-analysis, randomized controlled trial, reviews articles related to „thyroid nodules assessment”, „thyroid nodules management”, „thyroid nodules guidelines”, „thyroid nodules surgery”.
The initial assessment of thyroid nodules includes an evaluation of clinical, laboratory and sonographic risk factors. Due to the sonographic features and size, the nodules are selected for biopsy. Cytologically benign nodules are usually followed-up, minimally invasive techniques may be required in certain cases. In suspected or confirmed malignancy, the treatment options of thyroid nodules include surgery or active surveillance. The main controversies appear in management of nodules with inconclusive cytology, low-risk cancers, multinodular goiters, hyperfunctioning nodules, and thyroid incidentalomas.
Thyroid nodules due to the high incidence and heterogeneity of background diseases cannot be evaluated and managed in one standardized approach. In the existing literature, there are discussed multiple options for diagnosis and treatment of thyroid nodules. We have reviewed the guidelines recommendations, novel published data, and controversial questions for health care professionals, to understand and provide efficient, personalized, and cost-effective management of patients with thyroid nodules in order to avoid automatic intensive testing and intervention and balancing each case from the patient expectations and demands.