How Patients with Sporadic Nontoxic Goiter Should be Managed

Ultrasound examination is helpful for establishing the presence of multiple, nonpalpable, and cystic nodules and provides a baseline for subsequent comparison regarding nodule growth. Certain ultrasonic features in nodular goiter may suggest malignancy. Several groups54 56,57 have recommend performing an ultrasound-guided FNA biopsy of any nodule that is 1 cm or larger, hypoechoic, or solid or has microcalcifications, irregular borders, central blood flow, or an absent halo. Some clinicians suggest performing a biopsy on the dominant nodule. Papini and colleagues54 have documented invasive cancers (T4) in nodules smaller than 1 cm; thus, the size cutoff may not be accurate in predicting the malignant potential of all nodules, and suspicious nodules on ultrasound examination should be considered for biopsy. A selective approach seems to be indicated; that is, most occult nodules can be followed by ultrasound examination, but biopsy should be performed in suspicious occult nodules or nodules in high-risk patients.

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