Endocrine Abstracts

Introduction: Current guidelines recommend that thyroid nodules classified as Thy 3 following fine needle aspiration (FNA) should be managed surgically. This results in over-treatment of benign disease. The purpose of this study was to review multi-disciplinary team (MDT) management of Thy 3 FNAs at our institution.

Patients and methods: A total of 109 FNAs were performed between April 2008 and October 2009; 31 were reported as Thy 3. The management of all cases was discussed by the multi-disciplinary team (MDT).

Results: Seventeen patients underwent a diagnostic lobectomy. Four demonstrated malignancy (two papillary carcinomas and two follicular thyroid carcinomas). Two patients underwent repeat FNA prompting surgery in one patient (further Thy 3 result) and conservative management in the other (Thy 2).

Of the twelve patients who did not proceed to surgical intervention:

– Six patients were offered surveillance by ultrasound and/or radioisotope imaging following MDT consideration that the aspirate had been classified as Thy 3 based solely on the paucity of colloid.

Follow-up imaging has revealed no size increment at 6–12 months in five patients and progression to autonomous function in one patient.

– Five patients declined surgery.

– One patient demonstrated nodule resolution following initiation of levothyroxine therapy for hypothyroidism.

Conclusions: In 23.5% of patients with a Thy 3 FNA, who underwent a diagnostic lobectomy, histology confirmed thyroid carcinoma. Hence the majority of Thy 3 lesions were benign, in keeping with recent published data from other institutions in the UK. Patients with FNAs classified as Thy 3 based solely on the paucity of colloid (19%) with no additional suspicious features were offered conservative management. Short-term follow-up surveillance investigations have revealed no additional supportive evidence of malignancy in these patients but remains under close review.