From the Guidelines
A thyroid nodule classified as IA does not require immediate treatment, and regular monitoring with ultrasound every 1-2 years is typically recommended. This approach prioritizes the patient's quality of life and minimizes unnecessary interventions, given the very low risk of malignancy associated with these nodules [ 1 ]. The initial assessment and management of thyroid nodules should focus on evaluating the risk of malignancy, and in the case of IA nodules, this risk is less than 1%.
When considering the management of thyroid nodules, it is essential to weigh the potential benefits and harms of different approaches. In the case of IA nodules, the harms associated with overtreatment, such as unnecessary surgery or radioactive iodine therapy, outweigh the potential benefits [ 1 ]. Therefore, a conservative approach with regular monitoring is generally recommended.
Key considerations in the management of IA thyroid nodules include:
- Regular ultrasound monitoring to assess for changes in nodule size or characteristics
- Evaluation of symptoms, such as difficulty swallowing or voice changes, which may necessitate further evaluation or treatment
- Discussion of treatment options, including thyroid hormone therapy or fine needle aspiration, if concerning changes are detected
- Emphasis on patient education and shared decision-making to ensure that patients are informed and involved in their care [ 1 ].
By prioritizing a conservative approach and regular monitoring, patients with IA thyroid nodules can minimize their risk of unnecessary interventions and optimize their quality of life.
From the Research
IA en tyroid nodulo
- La evaluación de los nódulos tiroideos es crucial para determinar si son benignos o malignos 2, 3, 4.
- La mayoría de los nódulos tiroideos son benignos y no requieren tratamiento, pero es importante identificar los que pueden ser cancerosos o causar síntomas compressivos 2, 3.
- La ecografía es la mejor modalidad de imagen para evaluar los nódulos tiroideos y, cuando se indica, la biopsia por aspiración con aguja fina es la técnica adecuada para obtener muestras de los nódulos 4, 5.
- Los estudios han demostrado que la biopsia por aspiración con aguja fina guiada por ecografía no es necesaria de rutina para todos los pacientes, y que la tasa de resultados no diagnósticos y falsos negativos es similar con o sin guía por ecografía 6.
- La clasificación de los nódulos tiroideos en función de sus características ecográficas y de la biopsia por aspiración con aguja fina es fundamental para determinar el tratamiento y el seguimiento adecuados 2, 3, 5.
- La evaluación de los nódulos tiroideos debe incluir la historia clínica, el examen físico, la medición de la hormona estimulante del tiroides (TSH) y la ecografía, y, si se indica, la biopsia por aspiración con aguja fina y el análisis molecular 2, 3, 5.