Can a likely benign thyroid nodule be removed instead of yearly surveillance?

From the Guidelines

You can choose to have a TR4 thyroid nodule surgically removed even if it was found to be likely benign on aspiration, as this approach can help avoid the anxiety and hassle of yearly surveillance, although it's crucial to weigh the potential benefits against the risks of surgery. When considering surgical removal, it's essential to discuss the decision with your endocrinologist and surgeon, taking into account factors such as the nodule's size, any symptoms it causes, cosmetic concerns, or anxiety about potential future changes 1. The surgery would typically be a hemithyroidectomy (removal of half the thyroid) or a thyroidectomy (removal of the entire gland), depending on your specific situation.

Some key points to consider when making this decision include:

• The potential risks of surgery, such as bleeding, infection, damage to nearby structures like the recurrent laryngeal nerve (which can affect your voice), and the possible need for lifelong thyroid hormone replacement therapy, especially with complete thyroid removal 1.
• The fact that most thyroid nodules are benign, and the risk of malignancy is relatively low, as noted in the study by Vaccarella et al, which estimated that "overdiagnosis" accounts for 77% of thyroid cancer cases in the United States 1.
• The role of active surveillance as a safe and effective management strategy for low-risk papillary microcarcinoma, as demonstrated in the study by Miyauchi et al, which showed that active surveillance is a safe practice for patients, avoids adverse events of surgery, and is beneficial in regard to medical economy 1.
• The importance of individualized decision-making, taking into account the patient's preferences, values, and specific circumstances, as emphasized in the study by Tuttle et al, which highlighted the need for coordinated recommendations for "small" lesions 1.

Ultimately, the decision to surgically remove a TR4 thyroid nodule should be made on a case-by-case basis, considering the latest evidence and guidelines, as well as the patient's unique needs and preferences 1.

From the Research

Removal of Benign Thyroid Nodules

• The decision to remove a benign thyroid nodule, such as a TR4 nodule, depends on various factors, including the patient's overall health, the size and characteristics of the nodule, and the patient's preferences 2.
• Studies have shown that lobectomy, which involves removing the lobe of the thyroid gland containing the nodule, can be a effective treatment option for benign thyroid nodules, with a low risk of complications 3, 4.
• However, total thyroidectomy, which involves removing the entire thyroid gland, may be recommended in some cases, such as when the nodule is large or suspicious for cancer 5, 6.

Comparison of Lobectomy and Total Thyroidectomy

• A study published in 2002 compared the outcomes of patients who underwent lobectomy versus total thyroidectomy for dominant thyroid nodules, and found that total thyroidectomy was associated with a higher risk of complications, including hypoparathyroidism and nerve injury 2.
• Another study published in 2021 found that lobectomy was associated with a lower risk of recurrence and improved quality of life compared to total thyroidectomy for patients with differentiated thyroid cancer 3.
• A cost-effectiveness analysis published in 2020 found that lobectomy was a more cost-effective option than total thyroidectomy for patients with small nodules suspicious for papillary thyroid cancer 5.

Considerations for Patients with Benign Thyroid Nodules

• Patients with benign thyroid nodules should discuss their treatment options with their doctor, taking into account their individual circumstances and preferences 4, 6.
• The decision to remove a benign thyroid nodule should be based on a thorough evaluation of the patient's overall health and the characteristics of the nodule, rather than solely on the basis of the nodule's size or appearance 2, 3.