Spontaneous Resolution

The natural history of benign thyroid nodules has received scant attention in the past and is important to predict outcome and determine appropriate management. A long-term follow-up (6.1 years) study by Grant and associates48 of FNAC in 641 patients focused on the demonstration of a low false-negative rate of 0.7% but did not document exact changes in the untreated benign thyroid nodules, suffering from the inherent weakness of review by telephone, correspondence, or referring physician letter. However, the fate of putatively benign solitary thyroid nodules by clinical reexamination after 10 to 30 years has been studied by Kuma and colleagues,65 who demonstrated that most nodules reduce in size and nearly 36% disappear. There was, however, a malignancy rate of 26.3% in enlarging nodules. A more recent study by the same group66 has used physical re-examination (by the same two clinicians) and clinical and ultrasound-guided FNAC to assess the nature of nodules of 9 to 11 years' duration. This study again demonstrated that 99% of benign nodules remained benign; most decrease in size or disappear during this follow-up period. An increase in nodule size remains a worrying clinical feature (occurring in 21% to 23%), with a malignancy rate of 4.5%; clearly, there should be a high index of clinical suspicion for such enlarging lesions.

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