Endocrine Abstracts

The majority of thyroid nodules do not need treatment after the exclusion of malignancy or abnormal thyroid function due to the usually slow growth rate of benign thyroid lesions. Clinical and US follow-up should be performed every 1–2 years. A repeated US-FNA is appropriate only in case of relevant nodule growth or suspicious US changes. A minority of benign nodules present a progressive growth that causes local pressure symptoms or patient’s concern. To avoid unnecessary surgery, treatment options include percutaneous ethanol injection (PEI) for recurrent cystic lesions and TSH suppression with levothyroxine (T₄) or US-guided thermal ablation for solid nodules. A clinically significant decrease in nodule volume is obtained with T₄ only in a minority of patients. Routine use of T₄ therapy is not recommended but may be considered, with iodine supplementation, in younger patients from iodine-deficient areas who have small nodules with colloid features on cytology, or small size nodular goiters with no evidence of functional autonomy. If T₄ therapy is not indicated or the nodule grows during the course of treatment, surgery or image-guided mini-invasive procedures may be considered as therapeutic options. PEI is an alternative to surgery for complex nodules with a dominant fluid component. PEI is significantly superior to aspiration alone in reducing nodule volume with a volume decrease >50% in nearly 90% of cases. For solid benign nodules that cause local symptoms or patient’s concern, percutaneous thermal ablation with laser or radiofrequency may be considered as an effective debulking technique. These outpatient procedures are rapid and do not require high-cost devices. US and US-FNA have sharply decreased the rate of diagnostic surgery. US follow-up makes possible an easy and reliable monitoring of benign thyroid nodules. Mini-invasive procedures may further reduce the number of surgical treatments for symptomatic benign nodules.