From the Guidelines
The recommended follow-up for a 1.2 cm thyroid nodule with a Fine Needle Aspiration (FNA) showing benign adenoma is annual ultrasound surveillance.
Key Points
- The provided evidence does not directly address the follow-up for benign thyroid nodules, but it does discuss the diagnosis and management of thyroid cancer and nodules in general.
- According to the evidence, thyroid ultrasound (US) is a recommended diagnostic tool for detecting and characterizing nodular thyroid disease 1.
- The evidence suggests that fine needle aspiration cytology (FNAC) should be performed in any thyroid nodule >1 cm and in those <1 cm if there is any clinical or ultrasonographic suspicion of malignancy 1.
- Since the nodule in question is 1.2 cm and has been diagnosed as a benign adenoma, annual ultrasound surveillance is a reasonable approach to monitor for any changes in the nodule's size or characteristics.
- It is essential to note that the evidence provided is more focused on the management of thyroid cancer rather than benign nodules, so the approach may vary depending on individual patient factors and clinical judgment.
- In the absence of specific guidelines for benign adenomas, a conservative approach with regular monitoring seems prudent, taking into account the patient's overall health and risk factors 1.
From the Research
Follow-up Recommendations for Benign Thyroid Nodules
- The recommended follow-up for a 1.2 cm thyroid nodule with a Fine Needle Aspiration (FNA) showing benign adenoma is not strictly defined, but studies suggest that a follow-up interval of 3 years may be safe without increased mortality or patient harm 2.
- A study published in the Journal of the American College of Surgeons found that significant numbers of benign thyroid nodules enlarge more than 5 mm over 3 years, triggering repeat FNA or thyroidectomy, but larger diameter nodules and more rapidly growing nodules were not predictive of malignancy 3.
- The American Thyroid Association (ATA) ultrasound risk stratification system can be used to identify thyroid nodules in which fine-needle aspiration cytology (FNAC) should be performed, and to plan the long-term follow-up of patients with cytological benign thyroid nodules 4.
- A study published in the Thyroid journal found that the ATA US risk stratification system showed a very high accuracy in selecting nodules that did not require a second FNAC, and that an additional cytological evaluation may be avoided in benign thyroid nodules with low-risk US features, regardless of the evidence of growth during the follow-up 4.
- Another study published in the AJR American Journal of Roentgenology found that most malignant nodules that would not be biopsied using the ACR TI-RADS would undergo US follow-up, would be smaller than 1 cm, or would both undergo US follow-up and be smaller than 1 cm 5.
Factors to Consider in Follow-up
- Nodule size: larger nodules may be more likely to undergo thyroidectomy due to compressive symptoms 6.
- Nodule growth: significant growth over 3 years may trigger repeat FNA or thyroidectomy 3.
- US risk features: nodules with high-risk US features may require more frequent follow-up or repeat FNA 4.
- Patient age: younger patients may be more likely to undergo thyroidectomy 6.
- Patient preference: patient preference may play a role in the decision to undergo thyroidectomy 3.