Endocrinology Clinic Should Follow Thyroid Nodules
Thyroid nodules should be followed by endocrinology specialists, as endocrinologists perform the majority of thyroid nodule evaluations and fine-needle aspirations in current clinical practice. 1
Primary Specialty for Thyroid Nodule Management
- Endocrinologists manage thyroid nodules in 56.6% of cases, making them the primary specialty for thyroid nodule surveillance and evaluation 1
- Radiologists perform thyroid nodule evaluations in 31.9% of cases, typically focusing on imaging-guided procedures 1
- The endocrinologist's role encompasses the complete diagnostic algorithm: determining malignancy risk through ultrasound assessment, performing ultrasound-guided fine-needle aspiration biopsy (FNAB), interpreting cytology results, and coordinating long-term surveillance 2, 3
Rationale for Endocrinology Follow-Up
Comprehensive Thyroid Assessment
- Endocrinologists address both critical clinical issues in thyroid nodule management: (1) assessing for thyroid hormonal excess (hyperthyroidism) through TSH measurement and thyroid function testing, and (2) determining malignancy risk through ultrasound and FNAB 4
- The vast majority (95%) of thyroid nodules are benign and require surveillance rather than treatment, making endocrinology expertise in risk stratification essential 5
Surveillance Protocol Expertise
- Most benign thyroid nodules require no treatment and should undergo surveillance, with endocrinologists determining appropriate follow-up intervals based on ultrasound findings and cytology results 2
- Initial ultrasound surveillance occurs at 12-month intervals for untreated nodules 2
- Endocrinologists manage the nuanced decision-making for nodules requiring treatment versus observation, including those causing compression symptoms, nodules ≥2cm with gradual enlargement, cosmetic concerns, and autonomously functioning nodules causing hyperthyroidism 2
Surgical Referral Coordination
- While endocrinologists provide primary follow-up, they coordinate surgical referral when indicated for malignant or suspicious cytology 2, 3
- Surgery remains the treatment of choice for nodules with malignant or suspicious cytology, with the extent of surgery determined by postoperative risk stratification 2
- Endocrinologists maintain long-term follow-up even after surgical intervention, particularly for monitoring thyroglobulin levels and detecting recurrence in differentiated thyroid carcinoma 6
Post-Treatment Surveillance
- Following thyroid cancer treatment, endocrinologists conduct follow-up at 6-12 months aimed at ascertaining disease-free status through physical examination, neck ultrasound, and stimulated serum thyroglobulin measurement 6
- For patients undergoing thermal ablation of select papillary thyroid cancers, endocrinologists manage mandatory TSH suppression therapy with target TSH 0.5-2.0 mU/L for absolute indications 2