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Abstract
The solitary thyroid nodule is a common problem in clinical practice. It occurs in 4-7% of the population. It occurs more commonly in women and increases with advancing age. Most of single nodules are benign lesions, but approximately 5% of these nodules are true neoplasm. The clinician’s goal is to identify patients with malignant nodules who require surgical management, while avoiding unnecessary surgery in the majority of patients with benign thyroid nodules.
As for the management, a good history must be taken with a full clinical examination. Laboratory investigations include: T3, T4, TSH, autoimmune antibodies, serum Calcitonin and serum thyroglobulin. Laboratory tests give no great help in the evaluation of solitary thyroid nodules.
In case of using thyroid radioactive scanning, while it is sometimes helpful in cases of thyroid carcinomas, its principle value is in the diagnosis of an autonomous toxic nodule.
Ultrasonography of the thyroid gland is used in differentiating the true solitary thyroid nodules from those within a multinodular gland. Also it classifies the nodules into solid, cystic, or mixed. However, it gives little help in determining the pathological types of the nodule.
At present, FNAC has replaced other methods, and becomes the first and the routine method which must be used in diagnosis of solitary thyroid nodules. It has a great accuracy in identification of different pathologic types and in differentiating benign from malignant lesions, except in the follicular tumor group.
The methods of solitary nodule management depends chiefly on the scheme used in the diagnosis and treatment.
For the autonomous toxic nodule, the treatment is either by radioactive iodine or surgical resection. Recently, the third option for the treatment of toxic nodules is percutaneous ethanol injection.
For the cystic nodules, aspiration is both diagnostic and curative, with post aspiration observation. Sclerotherapy by tetracycline or ethanol injection is another promising method of treatment of the thyroid cyst. Thyroid lobectomy is recommended in patients with recurrent cysts.
The adenomatous colloid nodules are either observed or suppressed by thyroxin, also surgery is recommended if the nodule grows; for the exclusion of malignancy.
In thyroiditis, medical treatment takes the upper hand with fewer roles for surgery, which is mainly in the form of tracheal decompression or biopsy taking for assurance of diagnosis.
In benign neoplastic nodules, most patients with a benign solitary thyroid nodule on FNAC undergo observation or levothyroxine suppression therapy. However, surgery may be indicated in patients with a benign STN with high risk for malignancy.
In malignant lesions, total or near total thyroidectomy is performed with adjuvant treatment according to the type of malignancy, except in lymphoma whose response to chemotherapy and external radiation give good results.
US guided interstitial laser photocoagulation could become a useful non surgical alternative in the treatment of benign solitary solid cold thyroid nodule in patients who cannot or will not undergo surgery. It also may be used for reduction of the volume of neoplastic tissue prior to external radiation therapy or chemotherapy of local or distant recurrences of thyroid carcinoma that are not amenable to surgical or radioiodine treatments.
Although conventional open thyroidectomy can be performed with few complications, this approach leaves a visible scar on the anterior surface of the neck in a cosmetically unfavorable location. The minimally invasive endoscopic thyroidectomy approaches provide a superior cosmetic result when compared to conventional thyroidectomy and results in a quicker return to normal activity. Also it provides fantastic magnification of thyroid anatomy, including the recurrent laryngeal nerve, superior laryngeal nerve and the parathyroid glands.