Endocrine Abstracts

Thyroid nodules are a common clinical finding, with an estimated prevalence of palpable thyroid nodules to be approximately 5% in women and 1% in men. The clinical importance of thyroid nodules rests with the need to exclude thyroid cancer. The prevalence of malignancy reported for palpable thyroid lesions ranges from 5.0% to 6.5%. Patients with benign thyroid nodules are unlikely to suffer morbidity or mortality due to thyroid cancer. A 53 aged man presented with a 20-year history of a slow-growing nontender neck mass. He denied any compressive symptoms, such as dysphagia, dyspnea or hoarseness. On physical examination of the thyroid, the patient had a right-sided soft, elastic nodule larger than 10 cm of diameter. TSH, T4l were within normal range and thyroid antibodies were negative. CT scan of the neck indicated a solitary dominant nodule of the right thyroid lobe measuring 140×78×84 mm without invasion of adjacent structures. A minor compression and tracheal deviation to the left was also reported. Thyroid ultrasound indicated a large, heterogeneous nodule, solid with some cystic component and well-defined contours, occupying the entire right lobe of the thyroid gland. Left lobe also had a 1.4 cm solid nodule. FNAB of both nodules were benign. The patient remained asymptomatic throughout. Natural growth behaviour of thyroid nodules is controversially discussed. In our clinical case, the slow progression and the absence of compressive signs was suggestive of a benign lesion. However, the large dimensions and the progressive growth of the nodule might also be indicative of malignancy. There are few studies about long-term prognosis of thyroid nodules, including their malignant transformation. Although well established that approximately 90% of non-functioning thyroid nodules are benign, even in slow growth big nodules with benign FNAB, surgery is crucial to the final diagnosis.