Thyroid incidentaloma: palpable problems of an impalpable nodule
Carmen Vulpoi1, Voichita Mogos1, Delia Ciobanu2, Cristina Preda1, Cristina Cristea1, Maria-Christina Ungureanu1, Letitia Leustean1 & Eusebie Zbranca1
The widespread of sensitive imaging methods have substantially increased the incidental finding of subclinical thyroid nodules. The epidemic of thyroid incidentaloma has raised numerous discussions regarding their management: Is it necessary to investigate all nodules or is surveillance sufficient? Which criteria should be used in order to identify the nodules which must be investigated by fine-needle aspiration (FNA) (size, echogenicity, vascularisation)? Should we always rely on cytology? We performed an ultrasonographic screening in 535 subjects (190 males, 345 females, aged between 25 and 63 years-old) from a region with borderline iodine deficiency. Thyroid ultrasonography was performed with the same engine by 7 endocrinologists with similar training. Including criteria were absence of any known thyroid pathology and residency for >10 years in the investigatred area. Prior to the ultrasonography, thyroid was clinically examined. The incidence of thyroid nodules was 17.4%, concordant with literature data. After elimination of the palpable nodules, 9.7% were retained as true incidentaloma. Considering the diameters, 69% were micronodules, 18.4% had the main diameter between 1 and 1.5 cm and the rest had >1.5 cm. 2.6% of all subjects had positive antithyroid antibodies, and 1.4% patients had previously unknown thyroid dysfunction. Ultrasound-guided FNA was performed in 25 subjects and one (already suspicious on ultrasonography) had malignant cytology, postsurgical morphology confirming papillary thyroid carcinoma (7% of the explored nodules −4 to 12% in the literature data). We believe that subjects with nodules larger than 1 cm and those with suspicious ultrasound aspect should be investigated by ultrasound-guided FNAB, and smaller nodules with no other risk factors could be followed-up in 612 months. However this general attitude must be adapted to every individual case. Larger randomized prospective studies are necessary in order to propose a consensual diagnostic and management guide.