From the Guidelines
Benign follicular nodules are typically monitored with ultrasound every 6-12 months, and fine needle aspiration biopsy is the standard diagnostic procedure to confirm their benign nature, as recommended by recent guidelines 1.
Diagnosis and Monitoring
The diagnosis of benign follicular nodules involves the use of ultrasound and fine needle aspiration biopsy. According to the Thyroid Imaging Reporting And Data Systems (TIRADS), nodules with major diameters of less than 1 cm on US are recommended for surveillance, with exceptions for subcapsular nodules or those with suspicious metastatic neck lymph nodes 1.
- The TIRADS system is used to standardize the terminology used in thyroid US reports and minimize unnecessary fine needle aspiration (FNA) 1.
- Fine needle aspiration biopsy is the most accurate and cost-effective method for evaluating thyroid nodules, and it remains the gold standard for preoperative diagnosis of thyroid malignancy 1.
Treatment
No specific treatment is required for most benign follicular nodules, as they typically don't cause symptoms or health problems. However, if the nodule becomes large (greater than 4 cm), causes compressive symptoms like difficulty swallowing or breathing, or has cosmetic concerns, surgical removal may be considered.
- Surgical removal is typically considered for nodules that are causing symptoms or have suspicious features on ultrasound 1.
- Thermal ablation may be considered for patients with small classical papillary carcinoma, but this is not typically recommended for benign follicular nodules 1.
Quality of Life
Benign follicular nodules are common, occurring in up to 50% of adults, and most remain stable in size over time. The benign classification means these nodules have organized follicular cells without cellular atypia or invasive features that would suggest malignancy.
- Regular monitoring with ultrasound can help to ensure that the nodule doesn't grow significantly or develop concerning features, which can help to improve quality of life by reducing anxiety and uncertainty 1.
- Thyroid function tests may be required to ensure that the nodule isn't affecting hormone production, which can also help to improve quality of life by reducing symptoms related to thyroid dysfunction 1.
From the Research
Benign Follicular Nodule Diagnosis
- Fine-needle aspiration (FNA) biopsy is a reliable method for diagnosing benign follicular nodules, with an accuracy of cytologic diagnosis approaching 95% 2, 3.
- The procedure is safe, simple, and cost-effective, allowing for the selection of patients who need to undergo surgical excision 2.
- FNA biopsy is the preferred initial diagnostic test in all patients with thyroid nodules, rather than thyroid scanning or ultrasonography 2.
Management of Benign Follicular Nodules
- Benign nodules can be safely managed with a surveillance program, with the main goal of identifying the small subgroup of nodules that harbor a clinically significant cancer or cause compressive symptoms 4.
- Thyroid function testing and ultrasonographic characteristics guide the initial management of thyroid nodules, with certain ultrasound features suggesting a benign process that does not require additional testing 4.
- Management includes simple observation, local treatments, and surgery, and should be based on the estimated risk of malignancy and the presence and severity of compressive symptoms 4.
Follicular Neoplasms
- Follicular neoplasms of the thyroid are usually diagnosed following FNA biopsy of a dominant thyroid nodule, and represent a heterogeneous group of lesions including benign follicular hyperplasia, follicular adenomas, and follicular carcinomas 5.
- Approximately 20% of these lesions prove to be malignant, and for lesions greater than 1.0 cm in size, the majority of surgeons and endocrinologists recommend a total thyroidectomy 5.
- Postoperative treatment generally includes therapeutic doses of 131I for follicular carcinomas 5.