Which thyroid nodules should be treated with surgery?

Abstract

Aim: The objective of this work was to review the different conditions and characteristics of thyroid nodules that suggest surgical treatment. Background: A systematic literature searching was carried out in main databases (Medline, PubMed, EMBASE, LILACS, Google Academic, SciELO, and The Cochrane Library). The search was restricted to scientific papers published after 2005; only previous works that were inexcusable, specific references were included. The quality and consistency of the recommendations of treatment of thyroid nodules were systematically reviewed and assessed with the AGREE and AGREE-II guidelines. The different conditions and characteristics of thyroid nodules that suggest surgical treatment must be defined by valid, reliable, independent, and easily applied clinical-therapeutic guidelines. Several prestigious organizations from America, Europe, and Asia have developed guidelines containing recommendations for the surgical management of thyroid nodules. However, these recommendations may differ, and that could lead to confusion in many cases. Homogeneous guidelines are required to decide in which cases a thyroid nodule should be treated with a surgical intervention. Review results: Currently, fine needle aspiration under ultrasound guidance (FNA) has allowed cytological evaluation of non-palpable thyroid nodules from 2 mm in diameter. Nowadays, both ultrasound and FNA define–in most cases–whether or not a nodule requires surgery. Conclusion: Not all thyroid nodules require surgery. Surgical treatment is indicated in nodules with confirmed diagnosis or suspected malignancy, when the cytology of an FNA is undetermined, when goiter produces compressive symptoms, in cases of cervicothoracic goiters, recurrent cysts, or when the nodule grows during the follow-up. Clinical significance: To identify clinical and cytological characteristics in thyroid nodules to decide in which cases a thyroid nodule should be treated with surgery.