The thyroid noduleThe thyroid nodule
Faculty of Medicine and Health Sciences
Antwerp Surgical Training, Anatomy and Research Centre (ASTARC)
Jurnalul de chirurgie. - Ia«015F»i
4(2008):1, p. 51-60
University of Antwerp
Nodular disease of the thyroid is common; however, malignancy of the thyroid occurs in only 0.004% of the American population annually (12,000 new cases per y). About 5% of thyroid nodules are malignant; the remainder represent a variety of benign diagnoses, including colloid nodules, degenerative cysts, hyperplasia, thyroiditis, or benign neoplasms. A rational approach to management of a thyroid nodule is based on the clinician's ability to distinguish the more common benign diagnoses from malignancy in a highly reliable and cost-effective manner. A comprehensive history and physical examination provides the foundation for decision making in the management of thyroid nodules. The diagnosis algorithm includes lab tests, ultasound exam, scintigraphy and fine-needle aspiration biopsy. This paper also presents the technique of thyroidectomy and the risks factors for recurrent nerve palsy. It is also discussed the indications of the total versus subtotal thyroidectomies in different thyroid pathology. Conclusions: Thyroid nodular is still a frequent disease. All cold nodules are potentially malignant. Unilateral isthmo-lobectomy or bilateral thyroidectomy are the treatments of choice. Careful search to identify recurrent nerve is adviseable, and mandatory in bilateral disease. Neuromonitoring may be promising tool to prevent the recurrent nerve palsy. Bloodless surgery reduces the risk of nerve lesion.