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What Is the Appropriate Follow-up of Benign Thyroid Nodules
Peter J Mazzaglia, *Sarah Rapoport, *Saad Ajmal
Rhode Island Hospital, Providence, RI
Objective: To determine the appropriate nature and length of follow-up for patients with benign thyroid nodules
Design: Retrospective review
Setting: Single endocrine surgeon at a tertiary referral center
Patients: All patients referred for evaluation of thyroid nodules between September 2006 and December 2012 were reviewed. 181 who had benign fine needle aspiration (FNA) cytology and either underwent thyroidectomy or had at least a 1 year follow-up ultrasound were included.
Main Outcome Measures: Repeat FNA and pathology results
Results: There were 158 women and 23 men. Mean age was 53.4 ± 16.1. The largest diameter of the nodule at the first ultrasound was 2.76 ± 1.57 cm. 28 patients underwent immediate thyroidectomy, with pathology showing 25 benign, 1 papillary thyroid cancer (PTC) and 2 microcarcinomas (PTMC). 153 were followed with annual ultrasounds. Years of follow up ranged from 1--15 (median=2). 48.1% had at least 3 years of follow-up. During follow-up, 71 (46.4%) nodules underwent repeat FNA from 1—13 years (median=3) after initial biopsy. The mean increase in nodule diameter that triggered a repeat biopsy was 0.64 ± 0.70 cm. The repeat FNA cytology showed 90.3% benign, 8.3% follicular neoplasm, and 1.4% papillary thyroid cancer. During follow-up, 50 (32.7%) patients underwent thyroidectomy after 3.3 ± 2.8 years. Reasons for surgery included development of symptoms (60%), a non-benign repeat FNA (18%), or patient preference (22%). Surgical pathology identified 39 (78%) benign, 4 (8%) PTC, 5 (10%) PTMC, and 2 (4%) follicular cancer.
Conclusions: Significant numbers of benign thyroid nodules enlarge > 5 mm over 3 years, triggering repeat FNA or thyroidectomy. Development of thyroid cancer > 1 cm was < 5%.
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