This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by MOLITCH, M. E. Articles by PAUKERJ, S. G. Search for Related Content PubMed PubMed Citation Articles by MOLITCH, M. E. Articles by PAUKERJ, S. G.

The Cold Thyroid Nodule: An Analysis of Diagnostic and Therapeutic Options^*

MARK E. MOLITCH, J. ROBERT BECK^,, MITCHELL DREISMAN, JONATHAN E. GOTTLIEB and STEPHEN G. PAUKERJ

Division of Endocrinology, Department of Medicine New England Medical Center, Tufts University School of Medicine Boston, Massachusetts 02111
Division of Clinical Decision Making, Department of Medicine New England Medical Center, Tufts University School of Medicine Boston, Massachusetts 02111
Department of Pathology, Dartmouth-Hitchcock Medical Center Hanover, New Hampshire 03755

Correspondence: Address reprint request to: Mark E. Molitch, M.D., Center for Endocrinology, Metabolism and Nutrition, Northwestern University Medical School, 303 E. Chicago Ave., Chicago, IL 60611.

Abstract

Introduction: THE APPROPRIATE diagnostic evaluation and therapy of the patient with a solitary, nonfunctioning thyroid nodule remains controversial despite many cases [over 50,000 operations for suspected thyroid cancer per year (1)] and studies. Because only a minority of such nodules are malignant, a number of techniques have been proposed to identify patients with a low likelihood of malignancy, making it possible in these cases to defer surgery or to avoid it altogether. Thus, several alternative approaches to the initial management of a cold nodule have been advocated: 1) immediate surgical removal (2–10); 2) a trial of thyroid suppression for 3 to 6 months with subsequent surgical removal of nodules that do not regress and with continued suppression of nodules that do shrink (11–13); 3) suppression with thyroid hormone with only rare patients recommended for surgery (14); and 4) fine needle aspiration and cytologic examination with suspicious or malignant cells being indications for surgery (15–22).

Footnotes

^* Supported in part by training grant LM07027 from the Computers in Medicine Program, Grant LM03374 from the National Library of Medicine, and by Grant CA23108 from the National Cancer Institute, National Institutes of Health.

A portion of this paper was presented at the Fifth Annual Meeting of the Society for Medical Decision Making, Toronto, Ontario, October 3–5, 1983.

Dr. Beck is the recipient of New Investigator Research Award LM04038 from the National Library of Medicine.

Dr. Pauker was the recipient of Research Career Development Award GM00349 from the Institute of General Medicine Sciences, National Institutes of Health, Bethesda, Maryland.

This article has been cited by other articles:

				C. S. Hollenbeak, I. Lendel, K. S. Beus, J. M. Ruda, and B. C. Stack Jr The Cost of Screening for Synchronous Thyroid Disease in Patients Presenting With Primary Hyperparathyroidism Arch Otolaryngol Head Neck Surg, October 1, 2007; 133(10): 1013 - 1021. [Abstract] [Full Text] [PDF]

				M. H. Eckman Patient-Centered Decision Making: A View of the Past and a Look toward the Future Med Decis Making, May 1, 2001; 21(3): 241 - 247. [PDF]

				A. R. Hermus and D. A. Huysmans Treatment of Benign Nodular Thyroid Disease N. Engl. J. Med., May 14, 1998; 338(20): 1438 - 1447. [Full Text] [PDF]

				K. J. Brasel and J. A. Weigelt Blunt Thoracic Aortic Trauma: A Cost-Utility Approach for Injury Detection Arch Surg, June 1, 1996; 131(6): 619 - 626. [Abstract] [PDF]

				L. R. Petrone A Primary Care Approach to the Adult Patient With Nodular Thyroid Disease Arch Fam Med, February 1, 1996; 5(2): 92 - 100. [Abstract] [PDF]

				J. Benbassat, G. Zajicek, G. J. Van Oortmarssen, I. Ben-Dov, and M. H. Eckman Inaccuracies in Estimates of Life Expectancies of Patients with Bronchial Cancer in Clinical Decision Making Med Decis Making, August 1, 1993; 13(3): 237 - 244. [Abstract] [PDF]

				E. L. Mazzaferri Management of a Solitary Thyroid Nodule N. Engl. J. Med., February 25, 1993; 328(8): 553 - 559. [Full Text]

				L. J. Layfield, A. Reichman, K. Bottles, and A. Giuliano Clinical Determinants for the Management of Thyroid Nodules by Fine-Needle Aspiration Cytology Arch Otolaryngol Head Neck Surg, July 1, 1992; 118(7): 717 - 721. [Abstract] [PDF]

				T. J. O'Leary and P. Walker Thyroid Cysts: Does Cancer at Pathology Mean Clinical Cancer? Arch Intern Med, June 1, 1991; 151(6): 1228 - 1228. [Abstract] [PDF]

				J. F. Hamming, B. M. Goslings, G. J. van Steenis, H. van Ravenswaay Claasen, J. Hermans, and C. J. H. van de Velde The Value of Fine-Needle Aspiration Biopsy in Patients With Nodular Thyroid Disease Divided Into Groups of Suspicion of Malignant Neoplasms on Clinical Grounds Arch Intern Med, January 1, 1990; 150(1): 113 - 116. [Abstract] [PDF]

				J. P. KASSIRER, A. J. MOSKOWITZ, J. LAU, and S. G. PAUKER Decision Analysis: A Progress Report Ann Intern Med, February 1, 1987; 106(2): 275 - 291. [Abstract] [PDF]

				A. F. Krieg, T. W. Abendroth, and M. B. Bongiovanni What Is "Appropriate" Utilization of Diagnostic Tests?: Technical Performance, Diagnostic Performance, and Clinical Utility American Journal of Medical Quality, January 1, 1986; 1(3): 70 - 78. [PDF]