Tags

Type your tag names separated by a space and hit enter

Diagnosis and treatment of the solitary thyroid nodule. Results of a European survey.
Clin Endocrinol (Oxf). 1999 Mar; 50(3):357-63.CE

Abstract

BACKGROUND AND OBJECTIVE

The optimum diagnostic and therapeutic strategy for the euthyroid patient with a solitary thyroid nodule is still a matter of debate. The aim was to assess the attitudes towards management of such patients in clinical centres throughout Europe by means of a questionnaire.

DESIGN

The questionnaire was circulated to all clinical members of the European Thyroid Association (ETA). A case report was followed by diagnostic investigations and choice of therapy in the index case (a 42-year old woman with a solitary 2 x 3 cm thyroid nodule and no clinical suspicion of malignancy). Eleven variations of the basic case report were proposed in order to evaluate how each alteration would affect management.

MATERIAL

151 members replied to the letter and 110 individuals from 20 countries completed the questionnaire (corresponding to approximately two-thirds of the clinical members of the ETA). They represented clinicians who had diagnosed and treated more than 50 (76%) or less than 50 (24%) patients with nodular thyroid disease within the previous 6 months.

RESULTS

Based on the index case, basal serum TSH was the routine choice of 99% and serum T4 and/or free T4 were included by 70% of the respondents. Almost 50% included determination of serum thyroid autoantibodies (TPOab: 47%, Tgab: 26%) and 43% measured serum calcitonin. Thyroid scintigraphy was used by 66% (99mTc: 86%, 123I: 10%, 131I: 4%), ultrasonography (US) by 80% (size: 75%, grey scale: 57%, Doppler: 33%). Scintigraphy in addition to US was used by 58%. Fine-needle aspiration biopsy (FNAB) was routinely used by 99% of the respondents, and performed under US-guidance by 42%. Based on the individually chosen diagnostic tests indicating a benign solitary thyroid nodule, a nonsurgical strategy was advocated by 77%. Despite controversies on L-T4 treatment this treatment was supported by more than 40% of the clinicians. Surgery was advocated by 23% and the preferred technique was hemithyroidectomy (70%). Clinical factors raising suspicion of thyroid malignancy (e.g. family history of thyroid cancer, history of external radiation, rapid nodule growth and a large nodule of 5 cm) lead the majority (70-91%; P < 0.000001) to disregard FNAB results and to choose a surgical strategy.

CONCLUSIONS

The favoured diagnostic strategy in the workup of patients with a solitary thyroid nodule include determinations of serum TSH combined with serum T4 and/or free T4 followed by FNAB and US together with scintigraphy. A nonsurgical strategy was favoured by the majority supporting the use of L-T4 as the first choice. In case of clinical factors raising the likelihood of malignancy, the majority recommended diagnostic thyroidectomy despite FNAB suggesting a benign condition.

Authors+Show Affiliations

Department of Endocrinology, Odense University Hospital, Denmark. finn.bennedbaek@ouh.dkNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10435062

Citation

Bennedbaek, F N., et al. "Diagnosis and Treatment of the Solitary Thyroid Nodule. Results of a European Survey." Clinical Endocrinology, vol. 50, no. 3, 1999, pp. 357-63.
Bennedbaek FN, Perrild H, Hegedüs L. Diagnosis and treatment of the solitary thyroid nodule. Results of a European survey. Clin Endocrinol (Oxf). 1999;50(3):357-63.
Bennedbaek, F. N., Perrild, H., & Hegedüs, L. (1999). Diagnosis and treatment of the solitary thyroid nodule. Results of a European survey. Clinical Endocrinology, 50(3), 357-63.
Bennedbaek FN, Perrild H, Hegedüs L. Diagnosis and Treatment of the Solitary Thyroid Nodule. Results of a European Survey. Clin Endocrinol (Oxf). 1999;50(3):357-63. PubMed PMID: 10435062.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosis and treatment of the solitary thyroid nodule. Results of a European survey. AU - Bennedbaek,F N, AU - Perrild,H, AU - Hegedüs,L, PY - 1999/8/6/pubmed PY - 1999/8/6/medline PY - 1999/8/6/entrez SP - 357 EP - 63 JF - Clinical endocrinology JO - Clin Endocrinol (Oxf) VL - 50 IS - 3 N2 - BACKGROUND AND OBJECTIVE: The optimum diagnostic and therapeutic strategy for the euthyroid patient with a solitary thyroid nodule is still a matter of debate. The aim was to assess the attitudes towards management of such patients in clinical centres throughout Europe by means of a questionnaire. DESIGN: The questionnaire was circulated to all clinical members of the European Thyroid Association (ETA). A case report was followed by diagnostic investigations and choice of therapy in the index case (a 42-year old woman with a solitary 2 x 3 cm thyroid nodule and no clinical suspicion of malignancy). Eleven variations of the basic case report were proposed in order to evaluate how each alteration would affect management. MATERIAL: 151 members replied to the letter and 110 individuals from 20 countries completed the questionnaire (corresponding to approximately two-thirds of the clinical members of the ETA). They represented clinicians who had diagnosed and treated more than 50 (76%) or less than 50 (24%) patients with nodular thyroid disease within the previous 6 months. RESULTS: Based on the index case, basal serum TSH was the routine choice of 99% and serum T4 and/or free T4 were included by 70% of the respondents. Almost 50% included determination of serum thyroid autoantibodies (TPOab: 47%, Tgab: 26%) and 43% measured serum calcitonin. Thyroid scintigraphy was used by 66% (99mTc: 86%, 123I: 10%, 131I: 4%), ultrasonography (US) by 80% (size: 75%, grey scale: 57%, Doppler: 33%). Scintigraphy in addition to US was used by 58%. Fine-needle aspiration biopsy (FNAB) was routinely used by 99% of the respondents, and performed under US-guidance by 42%. Based on the individually chosen diagnostic tests indicating a benign solitary thyroid nodule, a nonsurgical strategy was advocated by 77%. Despite controversies on L-T4 treatment this treatment was supported by more than 40% of the clinicians. Surgery was advocated by 23% and the preferred technique was hemithyroidectomy (70%). Clinical factors raising suspicion of thyroid malignancy (e.g. family history of thyroid cancer, history of external radiation, rapid nodule growth and a large nodule of 5 cm) lead the majority (70-91%; P < 0.000001) to disregard FNAB results and to choose a surgical strategy. CONCLUSIONS: The favoured diagnostic strategy in the workup of patients with a solitary thyroid nodule include determinations of serum TSH combined with serum T4 and/or free T4 followed by FNAB and US together with scintigraphy. A nonsurgical strategy was favoured by the majority supporting the use of L-T4 as the first choice. In case of clinical factors raising the likelihood of malignancy, the majority recommended diagnostic thyroidectomy despite FNAB suggesting a benign condition. SN - 0300-0664 UR - https://www.unboundmedicine.com/medline/citation/10435062/full_citation L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=0300-0664&amp;date=1999&amp;volume=50&amp;issue=3&amp;spage=357 DB - PRIME DP - Unbound Medicine ER -