Endocrine Abstracts

Thyroid nodules are common in the population. Ultrasound would detect nodules, in about 25% of the adult and half of the elderly population(>60 years). Only 5% of these nodules are malignant, and 60–70% of the detected benign nodules, remains similar or decrease in size during the long term follow-up. Few nodules, i.e >1.3 cm, would function autonomously and cause thyrotoxicosis. Rarely, large single nodules or multinodulated glands could cause compressive symptoms, or esthetic problems. Thus the clinician should plan to treat a small subgroup of patients carrying either of the problems described above and could simply follow-up the majority of the patients without any intervention. Ultrasound is the main tool, which physicians themselves, should use for picking up the high risk cases and decide FNAB. After the initial definition of TIRADS by Horvath et al, other thyroid organizations (ATA, AACE/AME) and recently ETA, developed standardized US risk stratification systems for reporting US features. Aim is to reliably define US assessment categories that can be used to communicate the expected risk of thyroid cancer and define those to be referred for FNAB. After the initial evaluation, appropriate surgical or medical interventions should be undertaken if needed. İ.e.; Surgery for the malignant nodules and/or large compressing multinodulated glands. Percutaneous ethanol injection (PEI) for large cystic nodules. Radiofrequency, percuteneous laser ablation (RFA, PLA) or high intensity focused ultrasound (HIFU) for single or limited number of nodule(s) causing esthetic or compressive problems. Radioiodine for autonomously functioning nodules in benign glands. Majority of the nodules would require no management, and it is the physicians responsibility to avoid unwarranted surgical or invasive intervention. Thyroidectomy is still, frequently, unnecessarily performed, and 30–40% of the postsurgical hypothyroid patients is either under or over replaced.