Minimizing Overdiagnosis and Overtreatment in Patients With Thyroid Nodules
Posted: Thursday, February 18, 2021
An article published in The Journal of Clinical Endocrinology and Metabolism presented a review of the currently recommended practices for diagnosis and subsequent management of patients with thyroid nodules. Giorgio Grani, MD, PhD, of the Sapienza University of Rome, and colleagues found that the best strategies for disease outcomes and quality of life involve avoiding the pitfalls of overdiagnosis and overtreatment.
“Thyroid nodule evaluation is no longer a one-size-fits-all proposition. For most nodules, the likelihood of malignancy can be confidently estimated without resorting to cytology or molecular testing, and low-frequency surveillance is sufficient for most patients. When there are multiple options for diagnosis and/or treatment, they should be discussed with patients…to identify an approach that best meets their needs,” stated Dr. Grani and colleagues.
A total of 215 articles resulted from the researchers’ PubMed search. The most relevant articles were selected based on specific search terms with a preference for more recent publications. The articles were then used to synthesize evidence on initial workup and treatment recommendations for patients with thyroid nodules in an effort to avoid overtreatment.
The search revealed that the need for diagnostic surgery may be obviated if sonographic risk-stratification is used to estimate the risk of malignancy, the need for biopsy is evaluated based on nodule features and size, and molecular analysis of the aspirate is performed. They also found that management of nodules that are cytologically benign may be performed with long-term follow-up alone; if a malignancy is suspected, options include surgery (increasingly less extensive), active surveillance, or other minimally invasive techniques.
Disclosure: The authors reported no conflicts of interest.