The common case of thyroid nodular disease: a practical approach to care

Sarah J Glastras, Diana L Learoyd



Appropriate investigations are needed in patients presenting with thyroid nodules to determine the risk of malignancy and any need for surgical intervention. Most thyroid nodules are benign but require long-term follow up after the initial assessment.

Key Points

  • Thyroid nodules are very common and often asymptomatic.
  • Nodules may require fine-needle aspiration (FNA) biopsy depending on their size and ultrasound characteristics.
  • If the thyroid-stimulating hormone (TSH) level is low then a thyroid nuclear uptake scan is appropriate to assess for warm or hot nodule(s), which generally do not require FNA biopsy.
  • The Bethesda system of thyroid FNA cytology results now reports six categories, each with different management implications.
  • Thyroid malignancy is uncommon but surgery is sometimes required for diagnostic clarification and total thyroidectomy is required if malignancy is confirmed.