From the Guidelines
Benign thyroid nodules do not require treatment unless they cause symptoms, and regular monitoring with ultrasound every 6-12 months is recommended to check for changes in size or characteristics, as stated in the ACR Appropriateness Criteria for thyroid disease 1.
Diagnosis and Management
The majority of thyroid nodules are benign, and initiating workup can be costly for the patient and healthcare system, as biopsy is frequently followed by repeat imaging and surgery, despite the fact that the majority of small thyroid cancers are indolent 1.
- The American College of Radiology (ACR) has formed committees to publish guidance regarding the incidental thyroid nodule detected on imaging and ACR TI-RADS was conceived to aid management of thyroid nodules detected on ultrasound 1.
- For symptomatic nodules causing discomfort, difficulty swallowing, or cosmetic concerns, treatment options include thyroid hormone suppression therapy with levothyroxine, radioactive iodine ablation, or surgical removal (typically hemithyroidectomy) 1.
- If the nodule produces excess thyroid hormone, anti-thyroid medications like methimazole may be prescribed 1.
Monitoring and Follow-up
Most benign nodules remain stable or grow slowly over time, and patients should report any sudden increase in nodule size, new difficulty swallowing or breathing, voice changes, or development of hyperthyroid symptoms like palpitations, weight loss, or anxiety 1.
- Regular monitoring with ultrasound every 6-12 months is recommended to check for changes in size or characteristics, as stated in the ACR Appropriateness Criteria for thyroid disease 1.
- The role of imaging in the management of thyroid cancer and other thyroid diseases is essential, and the ACR has published guidance on the appropriate use of imaging in these cases 1.
From the Research
Characteristics of Benign Thyroid Nodules
- The majority of benign thyroid nodules are asymptomatic, remain stable in size, and do not require treatment 2, 3, 4
- A minority of patients with growing nodules may complain of local symptoms or have cosmetic concerns, and thus seek surgical consultation 2, 3
- Benign thyroid nodules can be frequently detected in the general population, with most of them being benign, although malignant cases are rising 5
Treatment Options for Benign Thyroid Nodules
- Ultrasound-guided minimally invasive procedures, such as percutaneous ethanol injection, laser photocoagulation, and radiofrequency ablation, can produce persistent shrinkage of thyroid nodules and improvement of local symptoms 2, 3, 5
- Levothyroxine (LT4) therapy can reduce nodule volume, but its effectiveness is limited and it may cause signs and symptoms of hyperthyroidism 6
- Radiofrequency ablation (RFA) seems to be suited for the management of small and medium nodules, while larger nodules may require repeated RFA treatments 3, 5
- Percutaneous ethanol injection represents the first-line treatment for relapsing thyroid cysts, while laser and radiofrequency ablation are effective for solid nonfunctioning nodules 2, 3
Follow-up and Monitoring of Benign Thyroid Nodules
- The majority of benign nodules remain stable over a period of monitoring, with some exhibiting spontaneous shrinkage or growth 4
- Ultrasound examination is recommended at a distance of 2 and 5 years following cytological evaluation, then every 4-5 years from then on 4
- Future studies should focus on patient-important outcome measures, especially health-related quality of life, and compare minimally invasive procedures with surgery 6