Thyroid nodules are a common finding and are now detectable in nearly every second adult in advanced age, particularly in women. Fortunately, according to the latest study results, only 1.1% of these nodules are malignant. The reasons for the increasing prevalence include persistent iodine deficiency and improved diagnostic techniques. Nodules are often discovered incidentally during ultrasound examinations of the carotid arteries or CT/MRI scans of the neck. The likelihood of carcinoma increases with nodule size, reaching approximately 5–15% for nodules larger than 1 cm.
The medical treatment strategy depends on the size and characteristics of a newly discovered nodule. Carcinomas often appear irregular and/or calcified on ultrasound, in addition to increasing in size. Laboratory tests, radioactive markers (e.g., scintigraphy), and fine-needle aspiration are also available. In addition to assessing thyroid activity (TSH), tumor markers can be measured. These are proteins that are present in healthy individuals but are excessively produced by certain tumors.
Nodules smaller than 1 cm with an unremarkable appearance should be monitored by the family doctor every 12 months, while suspicious findings should be checked every 3–6 months. Nodules larger than 1 cm, those with a tendency to grow, or those associated with signs of hyperthyroidism should primarily be further evaluated by a specialist, with a referral to a nuclear medicine specialist being appropriate. If there is continued suspicion of carcinoma, a fine-needle biopsy can provide information about malignant cells. If the suspicion of carcinoma is confirmed or if a hyperfunctioning “hot” nodule is present, surgery becomes unavoidable.