All patients with known or suspected thyroid nodules should undergo testing for thyrotropin levels, also known as ‘‘thyroid-stimulating hormone’’ (TSH). The risk of malignancy in a thyroid nodule has been shown to be significantly greater in patients with elevated TSH. Patients with a nodule and concomitant hypothyroidism have an adjusted odds ratio of malignancy in excess of 11.
The decision to refer for surgical evaluation depends to a great extent on the interpretation of the FNA. Reporting of FNA cytology varies between institutions and depends on the training and classification system used by the cytopathologist. Although the nomenclature may differ slightly, cytopathologists generally render their diagnoses within one of the following broad categories: nondiagnostic or inadequate, benign, cellular follicular lesion, follicular neoplasm, suspicious for malignancy, or malignant.
- Miller MC. The patient with a thyroid nodule. Med Clin North Am. 2010 Sep;94(5):1003-15. [Medline]
- American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009 Nov;19(11):1167-214. [Medline]