Endocrine Abstracts (2010) 22 P860

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

1Department of Endocrinology, UMF Gr.T.Popa, Iasi, Romania; 2Department of Morphology, UMF Gr.T.Popa, Iasi, Romania.

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 6–12 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.

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